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. 2022 Mar 30;18:101075. doi: 10.1016/j.ssmph.2022.101075

Table 2.

Description of studies on employment and mental health.

Authors
Date
Country Study design Study population Measure of employment Measure of health Statistical Analysis Main findings of employment and health Quality
Ahmad, 2020 Canada Cross sectional survey N = 49
Afghan refugees
Employment status PTSD: HTQ Chi square Employment was significantly associated with lower PTSD scores: prevalence of PTSD was zero in those employed and 59.1% in those unemployed (p = 0.02). High



Ahmad, 2020 Canada Longitudinal study N = 1924
Syrian refugees
Employment status Depression: PHQ-9 Chi square
Logistical regression
Unemployment was significantly associated with higher prevalence of depression symptoms at both baseline (x2 = 16.7, p < 0.001) and year 2 (x2 = 7.8, p = 0.005).
In the multinomial logistic model, employment was not significantly associated with depressive symptoms.
Moderate



Alemi, 2015 USA Cross sectional survey N = 130
Afghan refugees
Employment status General psychological distress: Afghan Symptom Checklist Multivariate linear regression Employment was not a significant predictor of psychological distress. Moderate



Ao, 2016 USA Cross sectional survey N = 423
Bhutanese refugees
Employment status
Unable to find work
Suicide risk, ideation, and exposure: 19-item measure Logistic regression Inability to find work (aOR = 11.1; 95% CI = 2.4–51.5) was one of the main post-migration difficulties associated with past suicidal ideation. Moderate



Aragon, 2019 Italy Cross sectional survey N = 67
Chinese Asylum seekers
Unemployment
Problems at work
Unable to find work
PTSD: HTQ Logistical regression 52.2% of the participants reported being unable to find work as a post migration living difficulty and this significantly increased the likelihood of having PTSD (OR = 2.22, 95% CI = 1.16–4.27, p = 0.016). Moderate



Baranik, 2018 USA Cross sectional survey N = 159
Refugees
Vocational stressor Anxiety: Warr's measure.
Depression: CES-D scale
Sleep disturbance: 3 items questionnaire
T-test and Regression Analysis Refugees experiencing discrimination as a vocational stressor reported higher levels of depression (p < 0.01), anxiety (p < 0.05) and sleep disturbances (p <0.01) than those who did not report discrimination. Only the association between discrimination and depression and anxiety held after controlling for other variables. Moderate



Beiser, 2001 Canada Prospective longitudinal study N = 608
South-East Asian Refugees
Employment status Depression: Inventory of 45 items Covariance structural equation model Unemployment only became significantly related to depression at year 2 (r = 0.113) and year 10 (r = 0.095). At 10 years follow up unemployment was associated with increased levels of depression among men but not among women. High



Beiser, 2006 Canada Cross sectional survey N = 647
South-East Asian refugees
Employment status Depression: Depressive Affect Measure Scale Multivariate regression Unemployment had significant and positive associations with depression levels (B = 1.57, SE = 0.64), p < 0.05. Unemployed refugees who had a strong commitment to their ethnic identity had a higher depression score (p < 0.001). For refugees endorsing a weak ethnic identity, unemployment had no impact on depression scores (p > 0.05). High



Barbieri, 2020 Italy Cross sectional survey N = 122
African refugees and asylum seekers
Employment status PTSD: PCL-5 Logistic regression Employment status did not significantly predict PTSD symptom severity. High



Brigg, 2013 New Zealand Cross sectional survey and interview N = 100
Refugees
Employment status Demoralisation: Demoralisation Scale ANOVA Participants who were unemployed had a significantly higher demoralisation score than those who were employed (p < 0.001). Low



Bhui, 2006 UK Cross sectional survey N = 143
Somali refuges
Employment status Mental disorders: M.I.N.I Logistical regression In the regression model, employment (full time or part-time) was associated with lower levels of mental disorder (aOR = 0.03, 95% CI = 0.01–0.61, p < 0.05) High



Blight, 2006 Sweden Cross sectional survey N = 413
Bosnia-Herzegovina refugees
Employment status
Yearly Economic Activity (EA)
General mental health: Goteborg Quality of Life instrument Logistical regression Unemployment was associated with a higher level of symptoms of poor mental health for men (OR = 8.01 (2.36–27.23) p = 0.001) but not women (OR 1.16 (0.46–2.40), p = 0.75). For women, working for longer periods was associated with poor mental health (OR 4.52 (1.25–16.31), p = 0.02). Moderate



Bogic, 2012 Germany
Italy
UK
Cross sectional survey N = 854
Former Yugoslavia Refugees
Employment status Mental Disorders: M.I.N.I Multivariate logistical regression Higher rates of mood disorders (major depression, dysthymia, hypomania, mania) were associated with being unemployed (aOR = 1.99(1.35–2.93, p = 0.001). Unemployment was not significantly associated with other mental disorders including PTSD anxiety disorders and substance use disorders. High



Briderkirk, 2021 Canada Longitudinal study N = 577
Syrian refugees
Hourly wage
Quality of employment
Satisfaction with wage and job
Job appropriateness
Stress: PSS-10
General mental health: RAND-36
Correlations

Hierarchical regression
General mental health was positively correlated with satisfaction with current wage (r = 0.28, p < 0.001), job appropriateness (r = 0.15, p < 0.001), job satisfaction (r = 0.32, p < 0.001), perceived control, (r = 0.51, p < 0.001). In the regression, general mental health was higher among refugees making enough money (B = 0.74, p = 0.01) and satisfied with their job (B = 0.64, p = 0.04). Job appropriateness and hourly wage did not significantly predict general mental health Moderate



Bryant, 2019 Australia Cross sectional study N = 1767
Refugees
Work as a post migration stressor Prolonged Grief Disorder: 4 item self reported-screening measure Chi square Refugees with probable Prolonged Grief Disorder were more likely to be unemployed. Only 5% those with PGD were employed compared to 27.8% with no PGD (p < 0.001) Low



Campbell, 2018 UK Longitudinal study N = 5678 baseline
N = 939 at the third follow-up, 21 months after baseline
Employment status
Current job appropriateness for skills and qualifications
Emotional wellbeing:
Question from (SF-36)
Ordered logistic regression In the unadjusted cross-sectional analyses, refugees who were unemployed or have a job lower than one's skills and qualifications had higher odds of poorer emotional wellbeing in (p < 0.05). However, in the longitudinal analysis it was no longer significant. High



Carlsson, 2006 Denmark Longitudinal study N = 139
Refugees from Iran, Iraq and Lebanon
Employment status PTSD: HTQ
Anxiety & Depression: HSCL-25
Wellbeing: WHOQOL-Bref
Multiple linear regression Being employed was negatively correlated with depression and anxiety scores, HSCL-25 total (β = −0.33, p < 0.001), HSCL-25 depression (β = −0.33, p < 0.001), HSCL-25 anxiety(β = -0.29, p < 0.01), HTQ PTSD (β = -0.32, p < 0.01).
Employment/self-employment was positively correlated with WHOQOL Bref mental (β = 0.49, p < 0.001) and WHOQOL Bref physical (β = 0.27, p < 0.001)
High



Cetrez, 2021 Sweden Cross sectional survey N = 140
Iraqi Refugees
Employment status Mental health: self-perceived health from the PC-PTSD screen Descriptive statistics Unemployment (68.4%) was one of the most commonly given explanations of mental ill-health Moderate



Cochran, 2013 USA Cross sectional survey N = 579
Bhutanese refugees
Being unable to find work Suicide ideation Logistic regression Being unable to find work (AOR = 11.1, CI (2.4–51.1) was one of the main post-arrival difficulties associated with suicidal ideation. Moderate



Cooper, 2019 Australia Longitudinal study Baseline, N = 2399
Wave 2, N = 2009
Wave 3, N = 1894
Refugees and asylum seekers
Employment status High Risk of Mental Illness: K6
PTSD: PTSD-8
Generalized linear mixed models Unemployment was not a significant predictor of mental illness. High



De Vroome, 2010 Netherlands Cross sectional survey N = 3269
Refugees
Employment status
Occupational status: International Socio-Economic Index (ISEI)
Depression: 4 item measure created for the study
General health: self-rated 5-point scale
Binary logistic regression (employment variable)
Linear regression (occupational status variable)
Depression was negatively associated with the odds of employment (OR = −0.192, SE = 0.044, p < 0.01) and occupational status (B = −2.110, SE = 0.750, p < 0.05).
General health problems were negatively associated with odds of employment (OR = −0.274, SE = 0.030, p < 0.01) and occupational status (B = −3.951, SE = 0.545, p < 0.01)
Moderate



Di Thiene, 2021 Sweden Prospective longitudinal study N = 2895 refugees
N = 3684 Migrants
N = 26936 Swedish born
Long-term unemployment (LTU)
Long-term sickness absence (LTSA)
Disability pension (DP)
Common mental disorders (depressive, anxiety, stress-related disorder according to the ICD-10) Cox proportional hazard regression models For those with common mental disorders, the adjusted risk estimates of long-term unemployment were higher for refugees from Africa, Asia and Europe outside EU25 (HR: 2.39, HR: 2.16 and HR: 1.61, respectively), compared to Swedish born individuals High



Drescher, 2021 Switzerland
Jordan
Turkey
Cross sectional survey N = 57 Switzerland
N = 61 Jordan
N = 46 Turkey
Refugees and asylum seekers
Employment Psychological distress: K10
Psychological functioning: WHODAS
Descriptive statistics In the Switzerland sample those who showed increased psychological distress (K10) and decreased psychological functioning (WHODAS), 18 (32%) expressed employment concerns, 16 (28%) stated concerns about finding a job/suitable job. Moderate



Drydakis, 2022 Greece Longitudinal study N= Refugees Written work contract: Y/N
Exposure to workplace abuse/threats: Y/N
Hourly wage lower than the corresponding national minimum wage: Y/N
Physical health: EQ-VAS
Depression: CESD
Correlation
Random effect regression Model
Physical health is negatively associated with the probability of workers not having a written contract of employment (r = − 0.61, p < 0.01) and with the probability of workers experiencing insults and/or threats in their present job (r = −0.45, p < 0.01).
The estimates suggest a positive association between depression and workers not having a written contract of employment (coef = 4.312, p < 0.01, or 18.5%), workers receiving a net hourly wage lower than the corresponding national minimum (coef = 5.005, p < 0.01, or 28.5%), and workers experiencing insults and/or threats in their present job (coef = 3.915, p <0.01, or 13.3%)
Moderate



Eisen, 2020 USA Longitudinal study N = 78
Torture surviving asylum seekers
Employment status PTSD: HTQ-30
Anxiety and Depression: HSCL-25
Multiple regression analysis Employment status was not independently associated with a change in PTSD symptom levels or depressive symptom levels. Participants' symptoms improved over time (B = −0.254, p = 0.001), independent of changes in measured post-migratory factors such as employment and housing. Low



Grochtdreis, 2020 Germany Cross sectional survey N = 6821
Refugees and asylum seekers
Employment status Physical and mental health status: SF12 Linear regressions Persons that were employed had higher mean PCS and MCS scores than unemployed persons (56.0 and 50.8 vs. 53.1 and 47.6).
Unemployed persons had lower PCS scores than employed persons (B = −1.6 (95% CI-2.42; −0.77), p < 0.001). Unemployment was statistically associated with lower MCS scores (B = −2.9 (95% CI = −4.01; 1.76), p < 0.001)
High



Helgesson, 2021 Sweden Longitudinal study N = 239,742 Refugees
N = 4133898 Swedish-born
Employment status
Disability pension
ICD-10 somatic/mental disorders Multivariate Cox Regression models Refugees with specific somatic/mental disorders especially neoplasms (HR: 1.72; 95% CI: 1.56 to 1.91), diseases in the musculoskeletal system (HR: 1.57; 95% CI: 1.47 to 1.67)) and circulatory system (HR: 1.33; 95% CI: 1.22 to 1.45) and depressive disorders (HR: 1.31; 95% CI: 1.21 to 1.41) had a higher risk of disability pension compared with Swedish- born individuals with similar disorders. High



Hermansson, 2003 Sweden Longitudinal study Total = 44 male refugees tortured (n = 22) non-tortured (n = 22) Employment status Anxiety & Depression: HSCL-25
PTSD: PTSS-10
Psychological Well-being: Self-rating scale, “How do you feel?”
Spearman correlation In the non-tortured group, being employed was negatively correlated with HSCL-25 anxiety (rs = −0.70, p < 0.001), HSCL-25 depression (rs = −0.66, p < 0.01) and HSCL-25 total (rs = −0.69, p < 0.001. There was also a significant negative correlation between employment and PTSS-10 (rs = −0.56, p < 0.01). There was a significant positive correlation between being employed and well-being (rs = 0.49, p < 0.05).
No significant associations between employment and mental health measures were observed in the tortured group.
Moderate



Hermansson, 2002 Sweden Longitudinal study Same sample as above Employment status Anxiety & Depression: HSCL-25
PTSD: PTSS-10
Psychological Well-being: Self-rating scale
Wilcoxon rank sum Unemployment was associated with a lower level of mental health according to the measure of HSCL-25 anxiety (W = −2.28, p < 0.05) and PTSS-10 (W = −2.06, p < 0.05). Unemployment was not significantly associated with depression or psychological wellbeing. Moderate



Hocking, 2015 Australia Cross sectional survey N = 98
Asylum seekers
Employment status PTSD: HTQ
Anxiety & Depression: HSCL-25
Mann-Whitney test
Multiple regression analyses
Mann-Whitney showed that being employed was associated with reduced severity of anxiety (U = 793, p = 0.03, n = 95) and depressive (U = 807, p = 0.04, n = 95) symptoms.
Asylum seekers who were not employed were more likely to be diagnosed with MDD (OR = 2.61, 95% CI, 1.11–6.13; p = 0.03, n = 95).
High



Hunkler, 2020 Germany Cross sectional survey N = 275
Syrian Refugees
Employment status General health: self-rated 5-point scale
Mental health: “generally feel anxious, depressed and/or stressed” Y/N
Structural integration model Overall health significantly increased the probability of employment by 3 percent (p < 0.05), while mental state showed no significant effect. High



Jeon, 2009 South Korea Cross sectional survey N = 367
North Korean Refugees
Employment status Depression: The Korean version of CES-D Multiple regression People without occupations were 2.289 times (95% CI, 1.386–3.780) more likely to report depressive symptoms than those with occupations. In the multiple regression analysis, having no occupation [OR = 2.198, 95% CI, 1.247–3.873] was correlated with depressive symptoms. High



Kashyap, 2019 USA Longitudinal study N = 323
Refugees and asylum seekers
Employment status Depression: PHQ-9
PTSD: HTQ
Self-reported chronic pain: Y/N
Linear regression Employment alone was not significantly associated with PTSD or depression. However, employment and stable housing together significantly moderated the relationship between lower chronic pain and reduced PTSD. Among individuals who reported experiencing chronic pain at the 6-month follow-up assessment (N = 170), lower chronic pain was associated with having stable housing (B = −0.89 (SE = 0.44), p < 0.05, β = −0.16) and with being employed (B = −0.83 (SE = 0.37), p < 0.05, β = −0.17. Moderate



Kim, 2011 South Korea Cross sectional survey N = 144
North Korean refugees
Employment status Psychological problems: Symptom Checklist-90-Revised (SCL-90-R):
Depression: CES-D
Stepwise logistic regression Unemployment was related to a higher prevalence of obsessive-compulsive symptoms (B = 2.769(0.022), p = 0.05) and psychoticism (B = 2.013(0.037), p < 0.05). No significant relationship between employment status and other psychiatric symptoms including somatization, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation High



Kim, 2016 USA Cross sectional survey N = 656
Latino and Asian refugees
Employment status Self-rated mental health: 5 point scale
Mental disorders: CIDI interview
OLS regressions
Logistic regression analyses
Being unemployed was not significantly associated with self-reported mental health, mood disorders or anxiety disorders.
Refugees who were not in the labor force had significantly higher odds (OR = 6.48 95% CI (2.05–20.49), p < 0.01) of being diagnosed with any of the three mood disorders (ie major depression, dysthymia, and intermittent explosive) measured in the survey
High



Laban, 2005 Netherlands Cross sectional
Survey and interview
N = 294
Asylum seekers
Employment status
- No permission to work
- Work below skill level
Mental disorders: CIDI interview Multivariate logistic regression Almost 75% of the asylum seekers who stayed more than 2 years in the Netherlands mentioned lack of work as an important stressor. No work/work below level had the highest OR for lifetime prevalence of depressive disorder (OR = 1.32 95%CI (1.08–1.61), one or more psychiatric disorders (OR 1.44, 95%CI (1.15–1.81) and one or more psychiatric disorders (excluding PTSD) (OR = 1.37, 95% CI (1.11–1.69). No work/work below level was not significantly associated with anxiety disorder. High



Marshall, 2005 USA Cross sectional
Interview
N = 490
Cambodian refugees
Employment status PTSD and depression: CIDI interview
Alcohol use disorder: Alcohol Use Disorders Identification Test
Bivariate Odds Ratio Unemployment was associated with higher rates of major depression (OR = 4.44, 95% CI (2.51–7.87), but not PTSD or alcohol use disorder. Moderate



Maximova, 2010 Canada Cross sectional interview N = 525
Refugees
Employment Status Self-rated changes in mental and physical health status Linear regression Of the post-migratory factors studied being employed (either part-time or full time) was associated with greater improvements in mental health (Beta = 0.13, 95%CI (0.01–0.19), p < 0.025).
Employment status did not have a significant relationship with physical health.
Moderate



Newman, 2018 Australia Cross sectional survey N = 190
Refugees
Perceived organizational support (POS): 6 items scale
Perceived supervisor support (PSS): 6 item questionnaire
Psychological wellbeing: Satisfaction with life scale Ordinary least squares (OLS) regression The relationship between POS and psychological wellbeing was fully mediated by psychological capital. The relationship between Perceived supervisor support (PSS) and psychological wellbeing was not significant High



Niederkrotenthaler, 2020 Sweden Longitudinal study N = 2017
Refugees
Duration of time unemployed
Duration of Sickness absence
Disability pension
Suicide attempt: ICD-10: X60-84 or Y10-34
Suicide: ICD-10 codes X60-84 or Y10-34 in the Causes of Death Register
Cox regression models No significant interaction effects were found for refugee status and employment measures regarding suicide attempts and suicide. Moderate



Niederkrotenthaler, 2020 Sweden Longitudinal study N = 216, 930
Refugees
Long term unemployment (>180 days) Mental disorders: ICD-10 codes Cox proportional-hazard regression models. Refugees without a mental disorder had an adjusted long-term unemployment HR of 2.68 (95% CI 2.65–2.71), which was above the aHR of refugees (aHR 2.33, 95% CI 2.29–2.38) with mental disorders.
Regarding the risk of long-term unemployment due to specific mental disorders, the highest aHRs were seen for anxiety disorders (aHR 2.09), PTSD (aHR 2.03), and other stress-related disorders (aHR 2.25).
Refugee status was a strong risk factor of long-term unemployment (HR 2.7), and neither mental disorders in general nor specific mental disorders further added to this risk.
Moderate



Renner, 2021 Germany Cross sectional survey N = 133
Syrian refugees
Employment status Anxiety: GAD-7
Depression: PHQ-9
PTSD: PDS-5
Somatization: PHQ-15
Multiple linear regression Employment status was not significantly associated with PTSD, anxiety, depression or somatization. High



Salo, 2015 USA Cross sectional survey N = 203
Vietnamese refugees
Job satisfaction: 11-item scale Psychological distress: Indochinese version of HSCL-25 Structural equation model (SEM) Job satisfaction was the only direct predictor of psychological distress in this study (b = −0.15, SE = 0.05, 95% CI (−0.25, −0.05), p < 0.01). Job satisfaction fully mediated the relationship between acculturation and psychological distress with a small effect (b = −0.07, p < 0.05). Moderate



Sidorchuk, 2017 Sweden Cross sectional survey N = 3619
Refugees
Employment status Psychological distress: GHQ-12 Logistic regression Unemployed or temporarily employed refugees had higher odds of distress (OR 2.91, 95% CI 2.20 to 3.85) when compared with permanently/self-employed refugees. Refugee women belonging to the temporarily employed group (OR 2.59 (1.53–4.39)) had higher odds of psychological distress compared with their male counterparts (OR 1.67 (0.88–3.14). High



Sonne, 2021 Denmark Randomised Control Trial N = 321
Refugees
Full time employment PTSD: HTQ
Anxiety and depression: HSCL-25, HAM-D and HAM-A
Hierarchical multiple regression analyses Full-time occupation was positively associated with improvement in HSCL-anxiety and HSCL-depression, but this effect disappeared when the level of functioning (baseline GAF-F) was added. Full-time occupation was not significantly associated with the other treatment outcomes including HTQ, HAM-A, and HAM-D Moderate



Sulaiman-Hill, 2012 New Zealand
Australia
Mixed methods
Cross sectional survey + qualitative interview
N = 81
Afghan and Kurdish refugees
Employment status Subjective Wellbeing: Personal Well Being Index
Psychological distress: K10
Mann Whitney U test Refugees who were not working had a higher risk of psychological distress (Median K10 score = 19), than those who were working (Median K10 score = 16) Z = 2.016, p < 0.05. There was no significant difference in subjective wellbeing between the employed and unemployed groups (p = 0.242). Moderate



Teodorescu, 2012 Norway Cross sectional survey N = 61
Refugees
Employment status PTSD: Structured Clinical Interview for DSM-IV-TR PTSD Module (SCID)
Mental disorders: MINI,
Structured Interview for Disorders of Extreme Stress (SIDES)
Psychological distress: HSCL-25
PTSD: Life events checklist, impact of event scale-revised
Kendall's tau-bs
Spearman's rho correlations
Unemployment status was positively associated with PTSD (τb = 0.316, p < 0.01) and PTSD + Disorders of extreme stress not otherwise specified (DESNOS) (τb = 0.276, p < 0.05) and total mental health diagnoses (τb = 0.290 p < 0.05).
Unemployment was also positively associated with depression symptom severity HSCL-25 (r = 0.289 p < 0.05).
Moderate



Tonsing, 2020 USA Cross Sectional Survey N = 242
Chin-Burmese Refugees
Employment related stressors Psychological distress: K10 Hierarchical regression analysis PMLD4 employment stressors were not significantly associated with psychological distress. High



Vinokurov, 2000 USA Cross sectional
Survey
N = 206
Former Soviet Union refugees
Work status
- Unemployed
- Underemployed
- Employed in one's field of professional expertise
Life satisfaction: Perceived Quality of Life scale MANOVA Those employed in a similar job to before arrival reported significantly higher life satisfaction than the underemployed who in turn reported a greater degree of life satisfaction than the unemployed (F = 20.75, p < 0.0005) Moderate



Walther, 2020 Germany Cross sectional survey N = 4325
Asylum seekers and refugees
Employment status Psychological distress: PHQ-4
Life satisfaction: Single item measure
Pooled multiple, hierarchical linear regressions Currently working is associated with reduced levels of distress (p < 0.01), but only for male respondents. Employment is not associated with life satisfaction High



Walther, 2020 Germany Cross sectional survey N = 2639
Refugees
Employment: Y/N Psychological distress: RHS-13 Poisson regression model Male refugees who reported psychological distress had a lower likelihood of employment (risk ratio 0.67 (0.52–0.86)) and reduced participation in integration courses (RR 0.90 (0.81–0.99)). High



Warfa, 2012 UK
USA
Cross sectional survey N = 189
Somali refugees
London group = 143
Minneapolis = 43
Employment: Y/N
Type of work: Skilled/Not skilled
Mental disorders: M.I.N.I Logistic Regression Employment status was found to have one of the biggest impacts on reducing the odds of major depression and aggregated psychological disorders (OR = 2.419, 0.70–8.34, 0.162; OR = 2.372, 0.51–10.95, 0.269) respectively. High



Wright, 2016 USA Longitudinal study N = 286
Iraqi refugees
Employment: Y/N PSTD: PCL—Civilian version
Depression: HADS
Hierarchical Logistic regression None of the mental health factors alone (baseline PTSD, baseline depression, pre-displacement trauma, post displacement trauma) was significant in predicting unemployment two years after arrival to the US. However, the interaction of the pre-and post-displacement trauma was predictive of employment status (β = 0.05, Wald = 4.19, OR = 1.05, p < 0.05). High



Yalim, 2020 USA
Turkey
Cross sectional survey N = 185
Syrians refugees
USA sample N = 82
Turkey sample N = 103
Employment status Anxiety and Depression: HSCL-25 Hierarchical regression model Employment status was not associated with HSCL-25 total score in the Turkey or USA sample. High