1. 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

2. 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

3. 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

4. Methods
Cohort of all non-pensioned young adults years, resident in Sweden at 31st of December 2004 (N=1,753,544)
Mental disorders were measured as in- or specialised outpatient healthcare
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

5. Multivariatea hazard ratios (HR) for disability pension, sick-ness absence, and unemployment (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 : Disability Pension/Sickness absence: ≥180 days of unemployment annually Sickness absence: ≥90 days of sickness absence Unemployment: ≥180 days of unemployment 2004, ≥90 days of sickness absence annually bNot significantly increased

6. Multivariate* hazard ratios (HR) for disability pension, sick-ness absence, and unemployment (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 : Disability Pension/Sickness absence: ≥180 days of unemployment annually Sickness absence: ≥90 days of sickness absence Unemployment: ≥180 days of unemployment 2004, ≥90 days of sickness absence annually ;

7. 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

8. Thank you for your attention!