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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Public Health 1/2015

Do open youth unemployment and youth programs leave the same mental health scars? - Evidence from a Swedish 27-year cohort study

BMC Public Health > Ausgabe 1/2015
Mattias Strandh, Karina Nilsson, Madelene Nordlund, Anne Hammarström
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12889-015-2496-5) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no financial competing interests and no non-financial competing interests.

Authors’ contributions

MS conceived of the study, MS, AH participated in the coordination of the study, MS, KN and AH participated in the design of the study, MS carried out the analyses, MS, KN MN drafted the manuscript. All authors read and approved the final manuscript.



Recent findings suggest that the mental health costs of unemployment are related to both short- and long-term mental health scars. The main policy tools for dealing with young people at risk of labor market exclusion are Active Labor Market Policy programs for youths (youth programs). There has been little research on the potential effects of participation in youth programs on mental health and even less on whether participation in such programs alleviates the long-term mental health scarring caused by unemployment. This study compares exposure to open youth unemployment and exposure to youth program participation between ages 18 and 21 in relation to adult internalized mental health immediately after the end of the exposure period at age 21 and two decades later at age 43.


The study uses a five wave Swedish 27-year prospective cohort study consisting of all graduates from compulsory school in an industrial town in Sweden initiated in 1981. Of the original 1083 participants 94.3 % of those alive were still participating at the 27-year follow up. Exposure to open unemployment and youth programs were measured between ages 18–21. Mental health, indicated through an ordinal level three item composite index of internalized mental health symptoms (IMHS), was measured pre-exposure at age 16 and post exposure at ages 21 and 42.
Ordinal regressions of internalized mental health at ages 21 and 43 were performed using the Polytomous Universal Model (PLUM). Models were controlled for pre-exposure internalized mental health as well as other available confounders.


Results show strong and significant relationships between exposure to open youth unemployment and IMHS at age 21 (OR = 2.48, CI = 1.57–3.60) as well as at age 43 (OR = 1.71, CI = 1.20–2.43). No such significant relationship is observed for exposure to youth programs at age 21 (OR = 0.95, CI = 0.72–1.26) or at age 43 (OR = 1.23, CI = 0.93–1.63).


A considered and consistent active labor market policy directed at youths could potentially reduce the short- and long-term mental health costs of youth unemployment.
Additional file 1: Table S1. The internalized mental health symptoms index (range 0 - 8)*. The table shows which combinations of the three variables that comprise the index correspond to which index values. (DOCX 14 kb)
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