Occupational Class Differences in Acute Mental-Health and Despair-Related Hospitalisations among the Labour Force in Finland 1990–2021

Abstract Purpose To investigate periodic developments in acute mental disorder and despair-related hospitalisations of different occupational classes in the Finnish labour force between 1990 and 2021, and to study whether there is periodicity in the social gradient of these hospitalisations. Methods Eight representative cohorts (around 33% of the population) were linked to the hospital discharge registry data and followed up until 2021. Eight periods were recognized based on the prevalence of hospitalisations due to self-harm, mood disorders, neurotic disorders, psychotic disorders, and substance-use related psychoses and poisonings. Periodic trends in occupational class differences were studied using Firth’s logistic regression stratified by gender. Results A social gradient persisted for mood disorders, neurotic disorders, non-organic psychoses, and drug poisonings among those in employment. Alcohol induced psychoses and poisonings decreased for all occupational groups while drug and medication related hospitalisations increased especially in the long-term unemployed group. Higher risk periods coincided with weaker national economy and the long-term unemployed group had the highest prevalence in all diagnoses studied. Conclusion Most of the studied diagnoses have clear periodicity and have become more prevalent in the late 2010s. Selection to employment has likely tightened while steady employment and income is protective of mental distress, contributing to the occupational class gradients.