Labour-market marginalisation after a mental disorder among young natives and immigrants living in Sweden Magnus Helgesson, PhD, Postdoc Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden Co-authors: P Tinghög, T Niederkrotenthaler, F Saboonchi, E Mittendorfer-Rutz  

Background In OECD, the prevalence of mental disorders is around 20 % Mental disorders are among young adults a major cause of labour market marginalisation Increasing migration to Europe from non-Western countries A high proportion of non-Western immigrants are outside the labour market

Aim Associations between having a mental disorder (divided into subgroups) and labour market marginalisation, i.e. disability pension, sickness absence and unemployment Differences in labour market marginalisation between immigrants (divided into subgroups based on region of birth) and native Swedes

Methods Cohort of all non-pensioned young adults 20-35 years, resident in Sweden at 31st of December 2004 (N=1,753,544) Mental disorders were measured as in- or specialised outpatient healthcare 2001-2004 Country of birth was categorized into Sweden, Western (4 subgroups) and non-Western (3 subgroups) countries Cox regression analyses with both fixed and time-dependent covariates and competing risks

Multivariatea hazard ratios (HR) for disability pension, sick-ness absence, and unemployment 2005-11 (N=1,753,544)   Disability pension Sickness absence Unemployment HR Schizophrenia/Psychoses 25.3 3.2 1.3 Retardation/Organic 14.4 2.1 1.2b Personality 12.6 2.6 1.2 Affective 8.2 Behavioural/Emotional 7.2 1.9 Neurotic/Stress/Somatoform 6.0 Substance abuse 3.5 1.1 aAdjusted for: All outcome measures: Age, sex, education, family situation, type of living area, work attachment 2004, somatic disorder 2004-10: Disability Pension/Sickness absence: ≥180 days of unemployment annually 2004-10. Sickness absence: ≥90 days of sickness absence 2004. Unemployment: ≥180 days of unemployment 2004, ≥90 days of sickness absence annually 2004-2010 bNot significantly increased

Multivariate* hazard ratios (HR) for disability pension, sick-ness absence, and unemployment 2005-11 (N=1,753,544)   Disability pension Sickness absence Unemployment HR Sweden 6.6 2.1 1.4 Western countries 4.8 1.9 1.8 Nordic countries 5.5 EU 5.3 1.7 Europe outside EU 4.4 2.0 North America/Oceania 1.5 Non-Western countries South America Asia 4.6 Africa *Adjusted for: All outcome measures: Age, sex, education, family situation, type of living area, work attachment 2004, somatic disorder 2004-10: Disability Pension/Sickness absence: ≥180 days of unemployment annually 2004-10. Sickness absence: ≥90 days of sickness absence 2004. Unemployment: ≥180 days of unemployment 2004, ≥90 days of sickness absence annually 2004-2010;

Conclusions The association was strongest between mental disorders and subsequent disability pension Native Swedes had higher risk estimates for disability pension and sick-ness absence, compared to both Western and non-Western immigrants Non-Western immigrants had higher risk estimates for unemployment compared to both Western immigrants and native Swedes Previous labour market attachment explained a great part of the association between mental disorders, immigrant status and all measures of labour market marginalisation

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