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. 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.