Job Loss and Prolonged Unemployment Increases Depressive Symptoms over Time Among Sexual and Gender Minority Adults

Background and Purpose: Social workers often work with people who struggle to maintain employment and who face mental health challenges. These related experiences often coexist. Sexual and gender minority (SGM) workers are vulnerable to unemployment in the United States and experience alarming rates of depression, particularly in the wake of anti-SGM policies and sentiment. The mental health impacts of negative changes in employment status (i.e., going from employed to unemployed) and prolonged unemployment are currently unknown among SGM populations. This is particularly pressing as SGM workers are at risk of job loss under the current government (e.g., funding cuts for LGBTQIA+ programs). Our purpose was to assess how changes in employment status are associated with depressive symptoms among SGM workers.

Methods: We conducted a longitudinal study with data from three annual health questionnaires (2021-2023) of The Population Research in Identity and Disparities for Equality (PRIDE) Study, an online, community-engaged, cohort study of SGM adult health in the United States. Participants were ≥18 years old, active in the labor market (employed or unemployed and looking for work), identified as SGM people, and were able to read and understand English. The exposure was changes in employment status (employed to unemployed; unemployed to employed) or prolonged unemployment (unemployed to unemployed) from 2021 to 2022. The outcome was mean levels of depressive symptoms measured using the 9-item Patient Health Questionnaire (PHQ-9) in 2023. Marginal structural models were used to evaluate the association between changes in employment and depressive symptoms.

Results: Of 2,245 SGM workers who completed the 2021 and 2022 annual questionnaires (median age at 2021 [IQR], 35.2 [29.3-45.2]), the most reported gender identities were non-binary (25.9%) and cisgender woman (25.3%), and the most reported sexual orientations were queer (50.8%) and bisexual (29.8%). The sample included 44 (2.0%) participants who remained unemployed from 2021 to 2022, 50 (2.2%) who lost employment, 70 (3.1%) who gained employment, and 2081 (92.7%) who maintained employment. PHQ-9 scores in 2023 were highest (i.e., more depressive symptoms) among those who remained unemployed (mean [SD]: 11.1 [6.4]), followed by those that lost employment (mean [SD]: 8.7 [5.7]), gained employment (mean [SD]: 7.2 [5.3]), and maintained employment (mean [SD]: 6.1 [5.3]). After adjustment, compared to participants who maintained employment from 2021 to 2022, participants who lost their employment had a 2.89-point increase in PHQ-9 scores (95% CI, 0.98-4.79) and those with prolonged unemployment had a 2.87-point increase (95% CI, 0.96-4.78). Participants who gained employment had a 1.11-point increase (95% CI, -0.32-2.55).

Conclusions and Implications: Job loss and prolonged unemployment are significant contributors to depression among SGM populations, and gaining employment may mitigate some of the effects of past unemployment. These findings support the need for interventions that promote employment and reduce exposure to unemployment within SGM communities in social work policies and practice. Social workers should ensure mental health supports are available for SGM people as they work towards employment. Further research should quantitatively assess gender differences and qualitatively explore reasons for loss of employment among SGM workers.