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Hospitalisation for depressive disorder following unemployment—differentials by gender and immigrant status: a population-based cohort study in Sweden
  1. Anna-Clara Hollander1,
  2. Daniel Bruce1,
  3. Jan Ekberg2,
  4. Bo Burström1,
  5. Solvig Ekblad1,3
  1. 1Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, Sweden
  2. 2Department of Economics and Statistics, Linnaeus University Centre for Labor Market and Discrimination Studies, Linnaeus University, Växjö, Sweden
  3. 3Cultural Medicine Unit, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
  1. Correspondence to Dr Anna-Clara Hollander, Department of Public Health Sciences, Tomtebodavägen 18 B, plan 9, Karolinska Institutet, S- 171 77 Stockholm, Sweden,


Background The association between unemployment and poor mental health in general is explained by both causation and selection. The aim was to study whether experiencing unemployment was a risk factor for hospitalisation for depressive disorder specifically, and whether gender and immigrant status modified the hypothesised risk.

Methods A register-based prospective cohort study, 2000–2006, of persons aged 18–64 with a strong connection to the Swedish labour market. Outcome: hospital admission for a depressive episode; F32 in International Classification of Diseases, 10th revision. Exposure: employment status. Explanatory variables: gender and immigrant status. Confounders: age group, education and marital status. Cox regression models were used to estimate HRs with 95% CIs.

Results The cohort comprised 3 284 896 adults, 47.5% women. An excess relative risk for hospitalisation was found among those who became unemployed (HR=1.94, 95% CI 1.85 to 2.03). Foreign-born women who experienced unemployment had the highest relative risk (HR=3.47 95% CI 3.02 to 3.98).

Conclusions Among persons with a strong connection to the labour market experiencing unemployment, is a risk factor for hospitalisation for depressive disorders. Unemployed foreign-born women had the highest relative risk compared with all Swedish born, all foreign-born men and to employed foreign-born women.


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