Low-quality employment trajectories and mental health disorders among Swedish and migrant workers

Abstract Aim This study aims to examine the effects of low-quality employment trajectories on severe common mental disorders (CMD) according to Swedish and foreign background. Methods This is a longitudinal study based on Swedish population registries (N = 2,703,687). Low- and high-quality employment trajectories observed across five years (2005-2009) are the exposure with severe CMD as outcome (2010-2017). Adjusted hazard ratios (HR) were calculated using Cox regression stratified according to background (first-generation (i) EU migrants, (ii) non-EU migrants, (iii) second-generation migrants, (iv) Swedish-born with Swedish background) and sex. The reference group were Swedish-born with Swedish background in a Constant high-quality employment trajectory. Results Second-generation migrants had an increased risk of CMD compared to Swedish-born with Swedish background when following low-quality employment trajectories (e.g., male in Constant low-quality HR: 1.53, 95% CI: 1.41-1.68). Female migrant workers, especially first-generation from non-Western countries in low-quality employment trajectories (e.g., Constant low-quality HR: 1.65, 95% CI:1.46 - 1.87), had a higher risk of CMD compared to female Swedish-born with Swedish background. The confidence interval for CMD risk showed little differences between migrant groups (1st and 2nd generation) compared to the reference group. Conclusions Low-quality employment trajectories appear to be determinants of risk for CMD, having a differential impact according to background of origin and sex. We observe a higher risk for severe CMD across migrant groups, especially second-generation migrants, compared to Swedish-born with Swedish background. Further qualitative research is recommended to understand the mechanism behind the differential mental health impact of low-quality employment trajectories according to foreign background. Key messages • First and second-generation migrants in low quality employment have higher risk of severe common mental disorders compared to Swedish born with Swedish background workers in low quality employment. • Policies targeting working conditions in low-quality employment and promoting workers mental well-being are essential to reduce this higher risk for developing CMD, especially for migrant populations.


Background:
Mental health problems and low economic capability increase the risk of social marginalization. However, few larger studies with a broad age group have investigated how the cumulative effect of having both these difficulties may affect social life. The purpose of this study was to examine the associations between having mental health problems or having low economic capability or reporting both, and social marginalization.

Methods:
The study is based on responses from 28 047 adults (> 18 years old) from the general population participating in The Norwegian Counties Public Health Survey 2019. The study had a cross-sectional design and included respondents' evaluation of own economic capability, mental health problems (HSCL-5) and social marginalization measured as lack of social support, low participation in organized social activities, low participation in other activities, missing someone to be with, feeling excluded and feeling isolated. Multivariable logistic regression was adjusted for sex and age.

Results:
Findings showed that having mental health problems or low economic capability were both associated with various measures of social marginalization with odds ratio [OR] 95% confidence interval [CI] ranging from OR 1.33; CI 1.23-1.43 to OR 12.63; CI 10.90-14.64. However, the odds of social marginalization strongly increased for respondents having both mental health problems and low economic capability compared to respondents without both these difficulties, with OR ranging from OR 2.08; CI 1. . Findings are preliminary.

Conclusions:
Having both mental health problems and low economic capability strongly increases the risk of social marginalization, far beyond the effect of each factor alone. Key messages: Having both mental health problems and low economic capability strongly increases the risk of social marginalization, far beyond the effect of each factor alone. Services should aim to develop multi-faceted approaches to meet multiple life-challenges to prevent social marginalization.

Aim:
This study aims to examine the effects of low-quality employment trajectories on severe common mental disorders (CMD) according to Swedish and foreign background.

Results:
Second-generation migrants had an increased risk of CMD compared to Swedish-born with Swedish background when following low-quality employment trajectories (e.g., male in Constant low-quality HR: 1.53, 95% CI: 1.41-1.68). Female migrant workers, especially first-generation from non-Western countries in low-quality employment trajectories (e.g., Constant low-quality HR: 1.65, 95% CI:1.46 -1.87), had a higher risk of CMD compared to female Swedish-born with Swedish background. The confidence interval for CMD risk showed little differences between migrant groups (1st and 2nd generation) compared to the reference group.

Conclusions:
Low-quality employment trajectories appear to be determinants of risk for CMD, having a differential impact according to background of origin and sex. We observe a higher risk for severe CMD across migrant groups, especially second-generation migrants, compared to Swedish-born with Swedish background. Further qualitative research is recommended to understand the mechanism behind the differential mental health impact of low-quality employment trajectories according to foreign background.

Background:
School climate is recognized as important for adolescent mental wellbeing. However, there is a lack of longitudinal studies, and most research focus on school climate as an antecedent of mental wellbeing while the relation could be in the opposite direction or bidirectional. Further, no study has examined this relation with analyses that separate betweenfrom within-person variability to properly assess intraindividual developmental processes.

Conclusions:
The findings support a unidirectional temporal relationship from mental wellbeing to perceptions of a caring school climate and underscore the importance of investigating the subject longitudinally and as a function of within-person fluctuations. From a public health view, the findings support the importance of systematic efforts to promote mental wellbeing to facilitate positive school experiences of adolescents of all social classes. Key messages: The study found a unidirectional temporal relation at the within-person level in adolescents where mental wellbeing predicted perceptions of a caring school climate, but not the other way around. The findings underline the importance of systematic public health efforts to promote mental wellbeing as one avenue to facilitate positive school experiences of adolescents of all social.