The role of refugee status and mental disorders regarding subsequent labour market marginalisation: a register study from Sweden

Abstract

Purpose This study aimed to assess the role of refugee status and specific mental disorders regarding subsequent labour market marginalisation. Methods Prospective 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. Results Mental 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). Conclusion Mental 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.

What is the association between post-traumatic stress disorder and unemployment after a disaster?

“…Moreover, given the fit of the alternative model, it is more probable that the appearance of PTSD cases explains the unemployment condition. This finding is novel in the literature reviewed and supports ideas such as the lack of clarity when the stress-unemployment cycle could begin [7,31], and the relationship between stressors, unemployment and mental health tends to be interdependent once it starts [7,9,32], in refugees [33,34], immigrants [35], men [36] and women veterans [37], and social workers, to name a few cases. For example, studies conducted on Iraqi refugees show that exposure before and after the event predicts unemployment by 91% [7].…”

Risk of labour market marginalisation among young refugees and non-refugee migrants with common mental disorders

“…As they therefore often end up in jobs below their formal educational level, this might contribute to high levels of both long-term unemployment as well as general labour market marginalisation as over qualification has been reported as a strong risk factor for health deterioration [38]. Despite efforts with free language training to all migrants, language barriers may still be a reason for discrepancies in long-term unemployment between subgroups of migrants as the training is voluntary, and some groups of migrants are underrepresented in those classes [6,39] In a previous study from our research group, we found that the risk of long-term unemployment among refugees with a common mental disorder was around two times higher compared to Swedish-born individuals with no mental disorder [40]. The aim of this study was to go one step further and deepen the analyses about pathways to labour market marginalisation specifically among individuals with a common mental disorder.…”

“…In a previous study from our research group, we found that the risk of long-term unemployment among refugees with a common mental disorder was around two times higher compared to Swedish-born individuals with no mental disorder [ 40 ]. The aim of this study was to go one step further and deepen the analyses about pathways to labour market marginalisation specifically among individuals with a common mental disorder.…”

Can Circumstances Be Softened? Self-Efficacy, Post-Migratory Stressors, and Mental Health among Refugees

“…The sub-group of refugees contains people who are defined by the UNCHR as “someone who is unable or unwilling to return to their country of origin owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group, or political opinion” ([ 3 ], page 3). This group is at high risk of developing mental health problems [ 4 , 5 , 6 , 7 ]. To illustrate, the prevalence of common mental health disorders among refugees is about twice as high compared to migrant worker populations [ 8 ].…”