Associations of employment gain, employment loss and prolonged unemployment with depressive symptoms over time among sexual and gender minority adults in the USA: a retrospective cohort study
AI Summary
SGM participants who remained unemployed had the highest 2023 PHQ-9 mean (11.1) versus maintained employment mean (6.1).
Employment loss and prolonged unemployment were associated with adjusted PHQ-9 increases of 2.84 and 2.97 points respectively.
Findings support health and social interventions to promote employment and reduce depression among sexual and gender minority adults.
BMJ Public Health. 2026 May 14;4(2):e003845. doi: 10.1136/bmjph-2025-003845. eCollection 2026.
ABSTRACT
INTRODUCTION: Sexual and gender minority (SGM) workers are vulnerable to unemployment and experience alarming rates of depression. We aimed to assess how changes in employment status are associated with depressive symptoms among SGM workers.
METHODS: This retrospective cohort study used 3 annual 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 labour market, identified as SGM people and completed at least the 2021 and 2022 questionnaires. Marginal structural models were used to assess the association between changes in employment status from 2021 to 2022 and depressive symptoms in 2023.
RESULTS: There were 2245 SGM workers included in this study who had a median age of 35.2 years (IQR, 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. Patient Health Questionnaire-9 (PHQ-9) Score in 2023 was highest (ie, most depressive symptoms) among those who remained unemployed (mean: 11.1), followed by those that lost employment (mean: 8.7), gained employment (mean: 7.2) and maintained employment (mean: 6.1). After adjustment, compared with participants who maintained employment from 2021 to 2022, participants who lost their employment had a 2.84-point increase in PHQ-9 scores (95% CI 0.97 to 4.71) and those with prolonged unemployment had a 2.97-point increase (95% CI 0.98 to 4.95) in 2023.
CONCLUSIONS: Unemployment is a meaningful contributor to depression among SGM populations. Health and social interventions should promote employment among SGM people.
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