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 ( Interpretation: Poorer employment quality was associated with higher levels of depressive symptoms among SGM workers. Funding: Dona Rockstad, Patient-Centered Outcomes Research Institute.