Midlife migration, employment status, and mental health: A Swedish register-based study

OBJECTIVES: Employment status is a key health determinant that impacts mental health through multiple mechanisms. Individuals who migrate in midlife may face particular labor market integration challenges, yet research on the mental health impacts of unemployment among midlife migrants, and how this varies by origin and gender, remains limited. This study investigates associations between employment status and psychiatric disorders among individuals who migrated after age 40, compared with Swedish-born individuals. STUDY DESIGN: Using Swedish administrative register data from 1997 to 2016, a retrospective cohort study was conducted among individuals who migrated after age 40 (n = 21,154) and an age-matched Swedish-born cohort (n = 1,403,098). METHODS: Gender-stratified Cox proportional hazard models estimated hazard ratios (HR) for outpatient and inpatient psychiatric care. Employed, Swedish-born individuals served as the primary reference group. RESULTS: Unemployment was associated with increased risks of psychiatric care across all origin groups (HRs from 1.35 to 3.74). For most migrant groups, risks were comparable to those of the unemployed Swedish-born. Nonetheless, indications of mental health inequalities between unemployed migrants and Swedish-born individuals were evident, most notably by the greater magnitudes of increased risk observed among European women and Nordic men. CONCLUSIONS: Among midlife migrants, unemployment was consistently associated with poorer mental health, yet its contribution to migrant-native mental health inequalities was only seen in specific groups. Findings highlight the importance of examining how migration background, together with gender and other social factors, shapes health risks, and promoting the socio-economic integration of midlife migrants to support health in later life.