The Impact of In-Work Poverty on Mental Health: A Cohort Study of the Swedish Population

Gevaert, Jessie, Johansson, Gun, Almroth, Melody, Baron, Sherry, Bodin, Theo, Hick, Rod ORCID: https://orcid.org/0000-0002-1218-0809 and Badarin, Kathryn 2025. The Impact of In-Work Poverty on Mental Health: A Cohort Study of the Swedish Population. Psychiatry Research 353 , 116745. 10.1016/j.psychres.2025.116745

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Abstract

Background In-Work Poverty (IWP) is an increasing phenomenon, and understanding its mental health consequences is crucial for addressing its individual and societal impacts. This study investigates if IWP is associated with an increased risk of mental health disorders in the Swedish population. Methods This register-based cohort study included 2590,742 Swedish workers (24–60 years old) at the 2013 baseline. Five exposure categories were defined using data on months worked during the baseline year and household income relative to the poverty line: i. full-year (non-poor) (reference); ii. IWP (full-year, poor); iii. part-year (non-poor); iv. part-year (poor); v. long-term unemployed. Outcomes included diagnosed mental health disorders and prescribed Selective Serotonin Reuptake Inhibitors (SSRIs). Sex-specific Hazard Ratios (HR) with 95 % Confidence Intervals (CI) were estimated using survival analysis from 2014 to 2019. Findings IWP was associated with an increased risk of diagnosed mental health disorders (men: HR 1.58, 95 %CI 1.51–1.66 and women: HR 1.30, 95 %CI 1.25–1.34) and SSRI prescriptions (men: HR:1.22 95 %CI 1.18–1.25 and women: HR:1.15 95 %CI 1.13–1.18) compared to the full-year (non-poor) category. Increased risks were found for all other employment categories, with the highest risks among those in the part-year poor category and long-term unemployment. Interpretation IWP was associated with an increased risk of mental ill-health. These findings highlight that employment alone does not safeguard mental health when economic security is lacking. Addressing drivers of IWP is critical for safeguarding workers' mental health. Policy must prioritise not only employment activation but also work stability and security to reduce mental health risks.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Schools > Social Sciences (Includes Criminology and Education)
Additional Information:	License information from Publisher: LICENSE 1: Title: This article is under embargo with an end date yet to be finalised.
Publisher:	Elsevier
ISSN:	0165-1781
Date of Acceptance:	24 September 2025
Last Modified:	01 Oct 2025 10:45
URI:	https://orca.cardiff.ac.uk/id/eprint/181433

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