Abstract
PurposeThis study aimed to assess the role of refugee status and specific mental disorders regarding subsequent labour market marginalisation.MethodsProspective cohort study of all refugees (n = 216,930) and Swedish-borns (n = 3,841,788), aged 19–60 years, and resident in Sweden in 2009. Hazard ratios (HRs) with 95% Confidence Intervals (CIs) for long-term unemployment (> 180 days) and disability pension (DP) were calculated with Cox regression analyses.ResultsMental disorders were more prevalent in refugees compared to Swedish-born individuals, with greatest differences seen for post-traumatic stress disorder (PTSD; refugees 1.3%; Swedish-born individuals 0.1%). Regarding long-term unemployment, refugees without a mental disorder had an adjusted HR (aHR) of 2.68 (95% CI 2.65–2.71) compared to Swedish-born individuals without mental disorders, which was above the aHR of refugees (aHR 2.33, 95% CI 2.29–2.38) and Swedish-born individuals (aHR 1.44, 95% CI 1.43–1.45) with mental disorders. Regarding DP, compared to Swedish-born individuals without mental disorders, the aHRs were 1.44 (95% CI 1.34–1.54) for refugees without, but 6.11 (95% CI 5.84–6.39) for refugees with mental disorders. Swedish-born individuals with mental disorder had an aHR of 3.96 (95% CI 3.85–4.07). With regard to specific disorders, the aHRs for refugees, as compared to Swedish-born individuals without mental disorders, were markedly increased for all disorders (e.g. PTSD: long-term unemployment aHR: 2.03 (95% CI 1.89–2.18); DP 7.07 (95% CI 6.42–7.78).ConclusionMental disorders are more prevalent in refugees than in Swedish-born individuals but do not appear to increase their risk of long-term unemployment. Refugee status and mental disorders strongly contribute to the risk of DP, indicating that factors beyond medical considerations contribute to their granting of DP.
Highlights
IntroductionI.e. severe problems in finding and keeping a job, is a growing and serious public health and economic problem in Europe [1]
Labour market marginalisation, i.e. severe problems in finding and keeping a job, is a growing and serious public health and economic problem in Europe [1]
It remains unclear if these patterns are consistent for refugees, and how mental disorders modify the effect of refugee status on different markers of labour market marginalisation, i.e. unemployment and disability pension
Summary
I.e. severe problems in finding and keeping a job, is a growing and serious public health and economic problem in Europe [1]. Social Psychiatry and Psychiatric Epidemiology (2020) 55:697–704 that non-Western immigrants with mental disorders had a higher risk of unemployment, but a lower risk of disability pension as compared to Swedish-born individuals with such disorders [9]. It remains unclear if these patterns are consistent for refugees, and how mental disorders modify the effect of refugee status on different markers of labour market marginalisation, i.e. unemployment and disability pension
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