The Impact of Employment on Immigrant Mental Health: Results from a National Survey (NESARC)

Background and Purpose: Mental illness and unemployment are both well-documented in the literature as having harmful, and even detrimental, impacts on individuals’ lives. However, less in known about the intersections of mental illness and unemployment within the U.S. immigrant population. This study sought to better understand the relationship between employment status and mental health among a sample of immigrants to the U.S., particularly whether immigrant mental health changed over time, based on employment status. This study seeks to answer the following research question: “Over time, are immigrants who become unemployed or remain unemployed, more likely to have mental health problems than immigrants who become employed or remain employed?”

Methods: Data was from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a three-wave, nationally representative dataset. Wave 1 and Wave 2 were used in this study as they included a repeated sample. Of the 43,093 NESARC participants at Wave 1, 12.4% (N=5,338) self-reported as an immigrant. The sample for this study (N = 3,732) included all participants who self-reported as an immigrant to the U.S., and who responded to employment questions at both Waves 1 and 2. The outcome measures of interest were the mental health diagnoses Generalized Anxiety Disorder (GAD), Post Traumatic Stress Disorder (PTSD), Major Depressive Disorder (MDD), and Alcohol Abuse and/or Dependence (AAD). The main independent variable of interest was employment status. Descriptive and cross-tabulations were examined, followed by complex samples multivariate logistical regression analysis. Four independent regression models were run, each with one of the four mental health measures (GAD, PTSD, MDD, and AAD). The logistic regression analyses examined whether the main effects of a negative employment status were associated with a mental health diagnosis at Wave 2, when controlling for other sociodemographic measures.

Results: Of the immigrant subpopulation, 17.7% (N=945) endorsed one or more mental health diagnoses at Wave 2. Additionally, 86.9% of the immigrant sample reported a positive employment status from Wave 1 to Wave 2, and 13.1% reported a negative employment status from Wave 1 to Wave 2. Bivariate results indicate that those with a mental health diagnosis of GAD, PTSD, or MDD at Wave 2 were more likely to have a negative employment status, and those with a mental health diagnosis of AAD were less likely to have a negative employment status. In the multivariate logistic regression models, negative employment status was a significant predictor of all mental health diagnoses. Participants were twice as likely to have GAD if they reported a negative employment status (OR=1.96, p<.01). And, participants who reported a negative employment status were 1.25 times more likely to have PTSD (p<.01), and 1.5 times more likely to have MDD (p<.01). Participants with a negative employment status were about half as likely to have AAD (OR=0.48, p<.01).

Conclusions: The results from this study indicate that unemployment has a negative impact on immigrant mental health, specifically for GAD, PTSD, and MDD diagnoses. Unemployment predicted lower odds of AAD. Discussion includes implications for social work practice, policy and research are presented.