Association of employment quality with depression among sexual and gender minority adults: a retrospective cohort study

Background Sexual and gender minority (SGM) people face concerning rates of low-quality employment, unemployment, and depression. Our objective was to center employment in SGM mental health research and assess associations between employment quality and depression. Methods This retrospective study used data from The PRIDE Study—a national, community-engaged, longitudinal cohort of SGM adults in the United States. Employment quality in 2021 was categorized as: standard, secure-income; standard, insecure-income; non-standard, secure-income; non-standard, insecure-income; and unemployed. Mean levels of depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9) from 2021 to 2023. Mixed-effects linear regression models were used to evaluate the association between employment quality and PHQ-9 scores. Findings Participants' (n = 3354) median age was 34.7 years; 53.1% (n = 1782) were cisgender (sexual minority), 46.9% (n = 1572) transgender and gender diverse (TGD; any sexual orientation), and 91.5% (n = 3070) were white or selected multiple race/ethnicities, including white. Participants occupied standard, secure-income (57.0%; n = 1913); standard, insecure-income (9.3%; n = 313); non-standard, secure-income (12.8%; n = 432); non-standard, insecure-income (14.9%; n = 500); and unemployed (5.9%; n = 196) groups. PHQ-9 scores were highest (i.e., greater depressive symptoms) among standard, insecure-income; non-standard, insecure-income; and unemployed groups. PHQ-9 scores were higher among TGD workers in all employment quality groups compared to cisgender workers. In adjusted models, workers in standard, insecure-income (difference = 0.98; 95% CI, 0.38–1.58; p = 0.001); non-standard, insecure-income (difference = 1.39; 95% CI, 0.88–1.90; p < 0.001); and unemployed (difference = 3.12; 95% CI, 2.38–3.85; p < 0.001) groups reported higher depressive symptoms compared to the standard, secure-income group. Interpretation Poorer employment quality was associated with higher levels of depressive symptoms among SGM workers. Funding Dona Rockstad, Patient-Centered Outcomes Research Institute.