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High-quality longitudinal evidence exploring the mental health risk associated with low-quality employment trajectories is scarce. We therefore aimed to investigate the risk of being diagnosed with common mental disorders, substance use disorders, or suicide attempt according to low-quality employment trajectories. A longitudinal register-study based on the working population of Sweden (N=2 743 764). Employment trajectories (2005-2009) characterized by employment quality and pattern (constancy, fluctuation, mobility) were created. Hazard ratios (HR) were estimated using Cox proportional hazards regression models for first incidence (2010-2017) diagnosis of common mental disorders, substance use disorders and suicide attempt as dependent on employment trajectories. We identified 21 employment trajectories, 10 of which were low quality (21%). With the exception of constant solo self-employment, there was an increased risk of common mental disorders (HR 1.07-1.62) and substance use disorders (HR 1.05-2.19) for all low-quality trajectories. Constant solo self-employment increased the risk for substance use disorders among women, while it reduced the risk of both disorders for men. Half of the low-quality trajectories were associated with a risk increase of suicide attempt (HR 1.08-1.76). Low-quality employment trajectories represent risk factors for mental disorders and suicide attempt in Sweden, and there might be differential effects according to sex - especially in terms of self-employment. Policies ensuring and maintaining high-quality employment characteristics over time are imperative. Similar prospective studies are needed, also in other contexts, which cover the effects of the Covid-19 pandemic as well as the mechanisms linking employment trajectories with mental health.

Precarious employment (PE) is non-standard employment with uncertain and unstable contract duration, low wages, and limited labour protections and rights. Research has associated PE with workers’ poor mental health and well-being; however, this association has been studied primarily using quantitative methods. This qualitative study seeks to examine the mechanisms between PE and mental health in the context of the COVID-19 pandemic in Ontario, Canada. Specifically, it aims to address: (Benach J, Muntaner C. Precarious employment and health: developing a research agenda. J Epidemiol Community Health. 2007;61(4):276.) How do PE and working conditions impact the mental well-being of workers and members of their close families or households?; and (Kreshpaj B, Orellana C, Burström B, Davis L, Hemmingsson T, Johansson G, et al. What is precarious employment? A systematic review of definitions and operationalizations from quantitative and qualitative studies. Scand J Work Environ Health. 2020;46(3):235–47.) How has the COVID-19 pandemic shaped these relationships? Semi-structured interviews were conducted with a sample of 40 individuals aged 25–55 engaged in PE during the first wave of the COVID-19 pandemic or whose employment was terminated due to the pandemic. Results showed that PE amplified mental health symptoms and illnesses for workers and their families. These experiences were described as chronic, where impacts were exerted on precariously employed workers through systemic discrimination and racism, colonialism, workplace hierarchies, and gendered ideologies. PE negatively impacted mental health through emotional stress about employment and income instability, insecurity, and loss; added pressure for households where both partners are engaged in PE; impacted ability to maintain or improve overall health and well-being; and barriers to social connectedness. Overall, this study characterizes multiple dimensions of PE and the consequences they have on the mental health of workers and their families.

This study aimed to examine the effects of low-quality employment trajectories on severe common mental disorders (CMD) according to Swedish and foreign background. In this longitudinal study based on Swedish population registries (N=2 703 687), low- and high-quality employment trajectories were the main exposures observed across five years (2005-2009), with severe CMD as outcome variable (2010-2017). Adjusted hazard ratios (HR) were calculated by means of Cox regression models and stratified according to Swedish and foreign background [first-generation (i) EU migrants, (ii) non-EU migrants, (iii) second-generation migrants, (iv) Swedish-born of Swedish background] and sex. The reference group was Swedish-born of Swedish background in a constant high-quality employment trajectory. Second-generation migrants had an increased risk of CMD compared to Swedish-born of Swedish background when following low-quality employment trajectories [eg, male in constant low-quality HR 1.54, 95% confidence interval (CI) 1.41-1.68]. Female migrant workers, especially first-generation from non-EU countries in low-quality employment trajectories (eg, constant low-quality HR 1.66, 95% CI 1.46-1.88), had a higher risk of CMD compared to female Swedish-born of Swedish background. The risk for CMD according to employment trajectories showed little differences between first- and second-generation migrants. Low-quality employment trajectories appear to be determinants of risk for CMD in association with Swedish or foreign background of origin and sex. Our study shows a higher risk for severe CMD in second-generation and non-EU migrant compared to Swedish-born of Swedish background in constant low-quality employment. Further qualitative research is recommended to understand the mechanism behind the differential mental health impact of low-quality employment trajectories according to foreign background.

World economies increasingly rely on non-standard employment arrangements, which has been linked to ill health. While work and employment conditions are recognized structural determinants of health and health equity, policies aiming to protect workers from negative implications predominantly focus on standard employment arrangements and the needs of workers in non-standard employment may be neglected. The aim of this study is to explore workers' experiences of gaps in labour regulations and social protections and its influence on their health and well-being across 6 countries with differing policy approaches: Belgium, Canada, Chile, Spain, Sweden, and the United States. 250 semi-structured interviews with workers in non-standard employment were analyzed thematically using a multiple case-study approach. There are notable differences in workers' rights to protection across the countries. However, participants across all countries experienced similar challenges including employment instability, income inadequacy and limited rights and protection, due to policy-related gaps and access-barriers. In response, they resorted to individual resources and strategies, struggled to envision supportive policies, and expressed low expectations of changes by employers and policymakers. Policy gaps threaten workers' health and well-being across all study countries, irrespective of the levels of labour market regulations and social protections. Workers in non-standard employment disproportionately endure economic risks, which may increase social and health inequality. The study highlights the need to improve social protection for this vulnerable population.

OBJECTIVE: This study investigates the association between parental precarious employment (PE) and the mental health of their adolescent children, with a particular focus on how the association differs based on whether the mother or father is in PE. METHODS: This register-based study used the Swedish Work, Illness, and Labor-market Participation (SWIP) cohort. A sample of 117 437 children aged 16 years at baseline (2005) were followed up until 2009 (the year they turned 20). A multidimensional construct of PE (SWE-ROPE 2.0) was used to classify parental employment as either precarious, substandard or standard. The outcome, adolescents’ mental disorders, was measured as a diagnosis of a mental disorder using ICD-10 codes or by prescribed psychotropic drugs using ATC codes. Crude and adjusted Cox regression models produced hazard ratios (HR) with 95% confidence intervals (CI) to estimate the association between parental PE and adolescents’ mental health. RESULTS: Adolescents with parents in PE exhibited a higher risk of developing mental disorders. The association was more pronounced for paternal PE (HR 1.22, 95% CI 1.10–1.35) compared to maternal PE (HR 1.11, 95% CI 1.00–1.21). These associations largely persisted after adjusting for important confounders, including parental mental health. CONCLUSION: This study addresses a significant gap in the literature on parental PE and adolescents’ mental health. As PE is growing more common across countries, this study provides relevant insights into the intergenerational role that parental low-quality employment may have in terms of mental health within families.

Background Canadian and American undergraduate universities grapple with gender-based violence, notably sexual violence (SV), primarily affecting women in their initial four months of university. However, an estimated 90% of survivors/victims do not report assaults, exacerbating psychological trauma and impacting resource allocation and the implementation of effective prevention strategies. Survivors/victims’ reluctance to report also denies them access to university accommodations and resources, impacting health and well-being. Immediate risks of SV include physical and emotional trauma, while long-term consequences encompass mental health conditions, educational setbacks, and economic losses. Objective This study aims to comprehensively review and synthesize literature on underreported SV in Canadian/American universities. Through assessment, we seek to understand the strengths and gaps in current knowledge. Collaborating with experts, we aim to co-create recommendations for revising colonialized policies and reporting procedures, potentially eliminating barriers and enhancing facilitators. Our primary question focuses on identifying SV reporting barriers and facilitators for Canadian/American undergraduate survivors/victims. Given that a significant number of students at Canadian and American universities identify as Indigenous, African Canadian/American, International, and 2SLBGTQIAA + and we would like to know if the barriers and facilitators to reporting SV differ for these students, we added several sub-questions exploring intersections of race, culture, and gender. Addressing these knowledge gaps will inform policymaking, guide policy revisions, and improve reporting pathways, ultimately enhancing student safety and fostering violence-free Canadian and American campuses. Design Databases inclusive of PubMED, CINHAL, PsycInfo, ERIC, and Web of Science as well as sources of grey literature were used to identify papers published between 2000 and 2024, from which we selected articles relevant to barriers and facilitators of reporting sexual violence in Canadian and American undergraduate universities. Results We will employ the PRISMA flow chart for the systematic search, selection, and inclusion of evidence. Each source’s key characteristics will be summarized in the text, while detailed information will be organized in tables and appendixes. Specific data, aligned with our primary and sub-questions, will be charted, and a narrative synthesis will be formulated using the results table. Conclusions The study’s results will offer a comprehensive overview of obstacles and factors influencing the reporting of sexual violence, highlighting variations based on cultural and sexual identities. Addressing these knowledge gaps will provide data for shaping recommendations, refining policies, and enhancing accessible reporting avenues. Ultimately, this contributes to improving student safety and fostering violence-free campuses in Canada and the United States (US).

OBJECTIVES: The aim of this study was to examine the mediating effect of the psychosocial work environment on the association between precarious employment (PE) and increased risk of common mental disorders (CMD), substance use disorders and suicide attempts. METHODS: This longitudinal register-study was based on the working population of Sweden, aged 25–60 years in 2005 (N=2 552 589). Mediation analyses based on a decomposition of counterfactual effects were used to estimate the indirect effect of psychosocial risk factors (PRF) (mediators, measured in 2005) on the association between PE (exposure, measured in 2005) and the first diagnosis of CMD, substance use disorders, and suicide attempts occurring over 2006–2017. RESULTS: The decomposition of effects showed that the indirect effect of the PRF is practically null for the three outcomes considered, among both sexes. PE increased the odds of being diagnosed with CMD, substance use disorders, and suicide attempts, among both men and women. After adjusting for PE, low job control increased the odds of all three outcomes among both sexes, while high job demands decreased the odds of CMD among women. High job strain increased the odds of CMD and suicide attempts among men, while passive job increased the odds of all three outcomes among women. CONCLUSION: The results of this study did not provide evidence for the hypothesis that psychosocial risks could be the pathways linking precarious employment with workers` mental health. Future studies in different social contexts and labour markets are needed.

Background Precarious employment is a significant determinant of population health and health inequities and has complex public health consequences both for a given nation and internationally. Precarious employment is conceptualized as a multi-dimensional construct including but not limited to employment insecurity, income inadequacy, and lack of rights and protection in the employment relation, which could affect both informal and formal workers. The purpose of this review is to identify, appraise, and synthesize existing research on the effectiveness of initiatives aiming to or having the potential to eliminate, reduce, or mitigate workers’ exposure to precarious employment conditions and its effects on the health and well-being of workers and their families. Methods The electronic databases searched (from January 2000 onwards) are Scopus, Web of Science Core Collection, and PubMed, along with three institutional databases as sources of grey literature. We will include any study (e.g. quantitative, qualitative, or mixed-methods design) evaluating the effects of initiatives that aim to or have the potential to address workers’ exposure to precarious employment or its effects on the health and well-being of workers and their families, whether or not such initiatives were designed specifically to address precarious employment. The primary outcomes will be changes in (i) the prevalence of precarious employment and workers’ exposure to precarious employment and (ii) the health and well-being of precariously employed workers and their families. No secondary outcomes will be included. Given the large body of evidence screened, the initial screening of each study will be done by one reviewer, after implementing several strategies to ensure decision-making consistency across reviewers. The screening of full-text articles, data extraction, and critical appraisal will be done independently by two reviewers. Potential conflicts will be resolved through discussion. Established checklists will be used to assess a study’s methodological quality or bias. A narrative synthesis will be employed to describe and summarize the included studies’ characteristics and findings and to explore relationships both within and between the included studies. Discussion We expect that this review’s findings will provide stakeholders interested in tackling precarious employment and its harmful health effects with evidence on effectiveness of solutions that have been implemented to inform considerations for adaptation of these to their unique contexts. In addition, the review will increase our understanding of existing research gaps and enable us to make recommendations to address them. Our work aligns with the sustainable development agenda to protect workers, promote decent work and economic growth, eliminate poverty, and reduce inequalities. Systematic review registration PROSPERO CRD42020187544 .

ObjectiveThis study compares the use of sickness absence benefits (SABs) due to a common mental disorder (CMD) between precariously employed and non-precariously employed workers with CMDs.DesignRegister-based cohort study.ParticipantsThe study included 78 215 Swedish workers aged 27–61 who experienced CMDs in 2017, indicated by a new treatment with selective serotonin reuptake inhibitors (SSRIs). Excluded were those who emigrated or immigrated, were self-employed, had an annual employment-based income <100 Swedish Krona, had >90 days of unemployment per year, had student status, had SABs due to CMDs during the exposure measurement (2016) and the two previous years, had an SSRI prescription 1 year or less before the start of the SSRI prescription in 2017, had packs of >100 pills of SSRI medication, had a disability pension before 2017, were not entitled to SABs due to CMDs in 2016, and had no information about the exposure.OutcomeThe first incidence of SABs due to CMDs in 2017.ResultsThe use of SABs due to a CMD was slightly lower among precariously employed workers compared with those in standard employment (adjusted OR [aOR] 0.92, 95% CI 0.81 to 1.05). Particularly, women with three consecutive years in precarious employment had reduced SABs use (aOR 0.48, 95% CI 0.26 to 0.89), while men in precarious employment showed weaker evidence of association. Those in standard employment with high income also showed a lower use of SABs (aOR 0.74, 95% CI 0.67 to 0.81). Low unionisation and both low and high-income levels were associated with lower use of SABs, particularly among women.ConclusionsThe study indicates that workers with CMDs in precarious employment may use SABs to a lower extent. Accordingly, there is a need for (1) guaranteeing access to SABs for people in precarious employment and/or (2) reducing involuntary forms of presenteeism.

[...]the authors use their findings to highlight the heterogeneous character of Indigenous populations and warn against using definitions, data collection, and analysis approaches that do not differentiate among subgroups and, as a result, do not facilitate accurate assessments of unique health outcomes and needs of distinct populations. Because their findings revealed that both demographic profiles and employment characteristics varied among the three Indigenous subgroups studied, they argue that a lack of disaggregated data and analysis approaches hinders the potential of public health research to address the range of health inequities affecting Indigenous groups. [...]by examining the occupational determinants of health and well-being for Indigenous populations, Shannon et al. show concern for the role of employment and the opportunity it presents for interventions to improve health and reduce health inequities. [...]we argue that a thorough understanding of the impact of employment on health requires the study of employment and working conditions, in addition to a focus on occupational factors. Implementation research is equally important to facilitate targeted action to improve employment and occupational outcomes among Indigenous populations through addressing the risk factors identified for each subgroup or strengthening aspects recognized for their health-enhancing potential. Because employment is increasingly recognized as a significant determinant of health, contributing to health and social inequities, a thorough understanding of employment-related determinants of health is a key prerequisite for improving population health.11,12 Accordingly, public health researchers interested in improving health and wellbeing among diverse populations, including Indigenous nations, should expand their focus from occupational determinants to the impact of employment and working conditions.