What is Career Counselling?

Introduction

Career counselling is a type of advice-giving and support provided by career counsellors to their clients, to help the clients manage their journey through life, learning and work changes (career).

This includes career exploration, making career choices, managing career changes, lifelong career development and dealing with other career-related issues. There is no agreed definition of career counselling worldwide, mainly due to conceptual, cultural and linguistic differences. However, the terminology of ‘career counselling’ typically denotes a professional intervention which is conducted either one-on-one or in a small group. Career counselling is related to other types of counselling (e.g. marriage or clinical counselling). What unites all types of professional counselling is the role of practitioners, who combine giving advice on their topic of expertise with counselling techniques that support clients in making complex decisions and facing difficult situations.

Terminology

There is considerable variation in the terminology that is used worldwide to describe this activity. In addition to the linguistic variation between US English (counselling) and British English (counselling), there are also a range of alternate terms which are in common use. These include:

  • Career guidance;
  • Career coaching;
  • Guidance counselling;
  • Personal guidance;
  • Career consulting; and
  • A range of related terminologies.

This frequently leads writers and commentators to combine multiple terms e.g. career guidance and counselling to be inclusive. However, care should be exercised when moving from one terminology to another as each term has its own history and cultural significance. An alternate term is ‘career guidance’. This term is sometimes used as a synonym for career counselling, but can also be used to describe a broader range of interventions beyond one-to-one counselling.

Brief History and New Approaches

Career counselling has a long history going back to at least as far as the late nineteenth century. An important defining work for the field was Frank Parsons’ Choosing a Vocation which was published in 1909. Parsons was strongly rooted in the American progressive social reform movement, but as the field developed it moved away from this origin and became increasingly understood as a branch of counselling psychology.

While until the 1970s a strongly normative approach was characterised for theories (e.g. of Donald E. Super’s life-span approach) and practice of career counselling (e.g. concept of matching), new models have their starting point in the individual needs and transferable skills of the clients while managing biographical breaks and discontinuities. Career development is no longer viewed as a linear process which reflects a predictable world of work. More consideration is now placed on nonlinear, chance and unplanned influences.

This change of perspective is evident in the constructivist and social constructionist paradigms for career counselling. The constructivist/social constructionist paradigms are applied as narrative career counselling that emphasizes personal stories and the meaning individuals generate in relation to their education and work.

Postmodern career counselling is a reflective process of assisting clients in creating self through writing and revising biographical narratives taking place in a context of multiple choice from a diversity of options and constraints. The shift moves from emphasizing career choice to empowering self-affirmation and improving decision making. Recently this approach is widely applied in Australia such as in Athlete Career and Education (ACE) programme by Australian Sports Commission and Scope for artists by Ausdance.

While career counselling has its origins in the USA and the English speaking world it has now spread to become a worldwide activity that can be found to some extent in all countries.

Career counselling includes a wide variety of professional activities which help people deal with career-related challenges. Career counsellors work with adolescents seeking to explore career options, experienced professionals contemplating a career change, parents who want to return to the world of work after taking time to raise their child, or people seeking employment. Career counselling is also offered in various settings, including in groups and individually, in person or by means of digital communication.

Several approaches have been undertaken to systemize the variety of professional activities related to career guidance and counselling. In the most recent attempt, the Network for Innovation in Career Guidance and Counselling in Europe (NICE) – a consortium of 45 European institutions of higher education in the field of career counselling – has agreed on a system of professional roles for guidance counsellors. Each of these five roles is seen as an important facet of the career guidance and counselling profession. Career counsellors performing in any of these roles are expected to behave professionally, e.g. by following ethical standards in their practice. The NICE Professional Roles (NPR) are:

  • Career educators “suppor[t] people in developing their own career management competences”.
  • Career information and assessment experts “suppor[t] people in assessing their personal characteristics and needs, then connecting them with the labour market and education systems”.
  • Career counsellors “suppor[t] individuals in understanding their situations, so as to work through issues towards solutions”.
  • Programme and service managers “ensur[e] the quality and delivery of career guidance and counselling organisations’ services”.
  • Social systems intervener and developers “suppor[t] clients (even) in crisis and works to change systems for the better”.

The description of the NICE professional roles (NPR) draws on a variety of prior models to define the central activities and competences of guidance counsellors. The NPR can, therefore, be understood as a state-of-the-art framework which includes all relevant aspects of career counselling. For this reason, other models have not been included here so far. Models which are reflected in the NPR include:

  • BEQU: “Kompetenzprofil für Beratende” (Germany, 2011).
  • CEDEFOP “Practitioner Competences” (2009).
  • ENTO: “National Occupational Standards for Advice and Guidance” (Great Britain, 2006).
  • IAEVG: “International Competences for Educational and Vocational Guidance” (2003).
  • Savickas, M.: “Career Counselling” (USA, 2011).

Benefits and Challenges

Benefits

Empirical research attests the effectiveness of career counselling. Professional career counsellors can support people with career-related challenges. Through their expertise in career development and labour markets, they can put a person’s qualifications, experience, strengths and weakness in a broad perspective while also considering their desired salary, personal hobbies and interests, location, job market and educational possibilities. Through their counselling and teaching abilities, career counsellors can additionally support people in gaining a better understanding of what really matters for them personally, how they can plan their careers autonomously, or help them in making tough decisions and getting through times of crisis. Finally, career counsellors are often capable of supporting their clients in finding suitable placements/ jobs, in working out conflicts with their employers, or finding the support of other helpful services. It is due to these various benefits of career counselling that policy makers in many countries publicly fund guidance services. For example, the European Union understands career guidance and counselling as an instrument to effectively combat social exclusion and increase citizens’ employability.

Challenges

One of the major challenges associated with career counselling is encouraging participants to engage in the process. For example, in the UK 70% of people under 14 say they have had no careers advice while 45% of people over 14 have had no or very poor/limited advice.

In a related issue some client groups tend to reject the interventions made by professional career counsellors preferring to rely on the advice of peers or superiors within their own profession. Jackson et al. found that 44% of doctors in training felt that senior members of their own profession were best placed to give careers advice. Furthermore, it is recognised that the giving of career advice is something that is widely spread through a range of formal and informal roles. In addition to career counsellors it is also common for psychologists, teachers, managers, trainers and Human Resources (HR) specialists to give formal support in career choices.

Similarly it is also common for people to seek informal support from friends and family around their career choices and to bypass career professionals altogether. In the 2010s, increasingly people rely on career web portals to seek advice on resume writing and handling interviews and to do research on various professions and companies. It has also possible to get a vocational assessment done online.

Training

There is no international standard qualification for professional career counsellors, although various certificates are offered nationally and internationally (e.g. by professional associations). The number of degree programmes in career guidance and/or career counselling is growing worldwide. The title “career counsellor” is unregulated, unlike engineers or psychologists whose professional titles are legally protected. At the same time, policy makers agree that the competence of career counsellors is one of the most important factors in ensuring that people receive high quality support in dealing with their career questions. Depending on the country of their education, career counsellors may have a variety of academic backgrounds. In Europe, for instance, degrees in (vocational/ industrial/ organisation) psychology and educational sciences are among the most common, but backgrounds in sociology, public administration and other sciences are also frequent. At the same time, many training programmes for career counsellors are becoming increasingly multidisciplinary.

Professional Career Guidance Centres

There are career guidance and counselling centres all over the world that give advice on higher studies, possibilities, chances and nature of courses and institutes. There are also services providing online counselling to people about their career or conducting psychometric tests to determine the person’s aptitude and interests.

Career Assessment

Assessment tools used in career counselling to help clients make realistic career decisions. These tools generally fall into three categories:

  • Interest inventories;
  • Personality inventories; and
  • Aptitude tests.

Interest inventories are usually based on the premise that if you have similar interests to people in an occupation who like their job, you will probably like that occupation also. Thus, interest inventories may suggest occupations that the client has not thought of and which have a good chance of being something that the client will be happy with. The most common interest inventory is a measure of vocational interests across six domains: Realistic, Investigative, Artistic, Social, Enterprising, Conventional. People often report a mixture of these domains, usually with one predominant domain.

Aptitude tests can predict with good odds whether a particular person will be able to be successful in a particular occupation. For example, a student who wants to be a physicist is unlikely to succeed if he cannot do the math. An aptitude test will tell him if he is likely to do well in advanced math, which is necessary for physics. There are also aptitude tests which can predict success or failure in many different occupations.

Personality inventories are sometimes used to help people with career choice. The use of these inventories for this purpose is questionable, because in any occupation there are people with many different personalities. A popular personality inventory is the Myers-Briggs Type Indicator. It is based on Carl Jung’s theory of personality, but Jung never approved it. According to Jung most people fall in the middle of each scale, but the MBTI ignores this and puts everyone in a type category. For example, according to the MBTI, everyone is either an extrovert or an introvert. According to Jung, most people are somewhere in between, and people at the extremes are rare. The validity of the MBTI for career choice is highly questionable.

Counsellors in Select Countries

In the United States

In the United States, the designation, “career counsellor” is not legally protected; that is, anyone can call themselves a career counsellor. However, CACREP, the accrediting body for counsellor education programmes requires that these programmes include one course in career counselling as a part of the coursework for a masters in counselling.

The National Career Development Association (NCDA), the credentialing body for career counsellors, provides various certifications for qualified career counsellors. For those university-trained counsellors or psychologists who have devoted a certain number of years to career counselling and taken specific coursework, it offers a Master Career Counsellor (MCC) credential. The National Career Development Association is the only professional association of career counsellors in the United States that provides certification in career counselling.

In Australia

In Australia, career counselling may be provided by professionals from various disciplines (e.g. psychology, education, guidance, and counselling). The Professional Standards for Australian Career Development Practitioners provide guidelines about appropriate qualifications and competencies for career counselling. There are a range of postgraduate degrees (e.g. Master, Doctor) that are endorsed for career development practice according to the Professional Standards. The Career Industry Council of Australia (CICA) endorses career development programmes in Australia. There are other relevant qualifications but these may necessarily not be endorsed under the provisions of the Professional Standards by CICA. A Diploma of Counselling and a Certificate IV in Career Development are offered at TAFE colleges and other registered training organisations throughout Australia.

In India

In India, career counselling is a vast area of professional service driven by factors like huge talent availability in the country and huge higher education network comprising Graduation, Post Graduation and multiple professional courses. There are many leading career guidance centres in India like. Leading bodies in India that drive policy level initiatives for students and working professionals are: Ministry of Human Resource Development (MHRD), University Grants Commission (UGC), All India Council of Technical Education (AICTE), National Skill Development Corporation (NSDC) among others.

What is Salutogenesis?

Introduction

Salutogenesis is the origins of health and focuses on factors that support human health and well-being, rather than on factors that cause disease (pathogenesis).

More specifically, the “salutogenic model” was originally concerned with the relationship between health, stress, and coping through a study of holocaust survivors. Despite going through the dramatic tragedy of the holocaust, some survivors were able to thrive later in life. The discovery that there must be powerful health causing factors led to the development of salutogenesis. The term was coined by Aaron Antonovsky, a professor of medical sociology. The salutogenic question posed by Aaron Antonovsky is, “How can this person be helped to move toward greater health?”

Antonovsky’s theories reject the “traditional medical-model dichotomy separating health and illness”. He described the relationship as a continuous variable, what he called the “health-ease versus dis-ease continuum”. Salutogenesis now encompasses more than the origins of health and has evolved to be about multidimensional causes of higher levels of health. Models associated with salutogenesis generally include wholistic approaches related to at least the physical, social, emotional, spiritual, intellectual, vocational, and environmental dimensions. A comparison of the salutogenic model with the traditional pathogenic model is provided in the below video.

Derivation

The word “salutogenesis” comes from the Latin salus = health and the Greek genesis = origin. Antonovsky developed the term from his studies of “how people manage stress and stay well” (unlike pathogenesis which studies the causes of diseases). He observed that stress is ubiquitous, but not all individuals have negative health outcomes in response to stress. Instead, some people achieve health despite their exposure to potentially disabling stress factors.

In his 1979 book, Health, Stress and Coping, Antonovsky described a variety of influences that led him to the question of how people survive, adapt, and overcome in the face of even the most punishing life-stress experiences. In his 1987 book, Unraveling the Mysteries of Health, he focused more specifically on a study of women and aging; he found that 29% of women who had survived Nazi concentration camps had positive emotional health, compared to 51% of a control group. His insight was that 29% of the survivors were not emotionally impaired by the stress. Antonovsky wrote: “this for me was the dramatic experience that consciously set me on the road to formulating what I came to call the ‘salutogenic model’.”

In salutogenic theory, people continually battle with the effects of hardship. These ubiquitous forces are called generalised resource deficits (GRDs). On the other hand, there are generalised resistance resources (GRRs), which are all of the resources that help a person cope and are effective in avoiding or combating a range of psychosocial stressors. Examples are resources such as money, ego-strength, and social support.

Generalised resource deficits will cause the coping mechanisms to fail whenever the sense of coherence is not robust to weather the current situation. This causes illness and possibly even death. However, if the sense of coherence is high, a stressor will not necessarily be harmful. But it is the balance between generalised resource deficits and resources that determines whether a factor will be pathogenic, neutral, or salutary.

Antonovsky’s formulation was that the generalised resistance resources enabled individuals to make sense of and manage events. He argued that over time, in response to positive experiences provided by successful use of different resources, an individual would develop an attitude that was “in itself the essential tool for coping”.

Sense of Coherence

The “sense of coherence” is a theoretical formulation that provides a central explanation for the role of stress in human functioning. “Beyond the specific stress factors that one might encounter in life, and beyond your perception and response to those events, what determines whether stress will cause you harm is whether or not the stress violates your sense of coherence.” Antonovsky defined Sense of Coherence as:

“a global orientation that expresses the extent to which one has a pervasive, enduring though dynamic feeling of confidence that (1) the stimuli deriving from one’s internal and external environments in the course of living are structured, predictable and explicable; (2) the resources are available to one to meet the demands posed by these stimuli; and (3) these demands are challenges, worthy of investment and engagement.”

In his formulation, the sense of coherence has three components:

  • Comprehensibility: a belief that things happen in an orderly and predictable fashion and a sense that you can understand events in your life and reasonably predict what will happen in the future.
  • Manageability: a belief that you have the skills or ability, the support, the help, or the resources necessary to take care of things, and that things are manageable and within your control.
  • Meaningfulness: a belief that things in life are interesting and a source of satisfaction, that things are really worthwhile and that there is good reason or purpose to care about what happens.

According to Antonovsky, the third element is the most important. If a person believes there is no reason to persist and survive and confront challenges, if they have no sense of meaning, then they will have no motivation to comprehend and manage events. His essential argument is that “salutogenesis” depends on experiencing a strong “sense of coherence”. His research demonstrated that the sense of coherence predicts positive health outcomes.

Fields of Application

Health and Medicine

Antonovsky viewed his work as primarily addressed to the fields of health psychology, behavioural medicine, and the sociology of health. It has been adopted as a term to describe contemporary approaches to nursing, psychiatry, integrative medicine, and healthcare architecture. The salutogenic framework has also been adapted as a method for decision making on the fly; the method has been applied for emergency care and for healthcare architecture.

Workplace

The sense of coherence with its three components meaningfulness, manageability and understandability has also been applied to the workplace.

Meaningfulness is considered to be related to the feeling of participation and motivation and to a perceived meaning of the work. The meaningfulness component has also been linked with Job control and with task significance. Job control implies that employees have more authority to make decisions concerning their work and the working process. Task significance involves “the experience of congruence between personal values and work activities, which is accompanied by strong feelings of identification with the attitudes, values or goals of the working tasks and feelings of motivation and involvement”.

The manageability component is considered to be linked to job control as well as to access to resources. It has also been considered to be linked with social skills and trust. Social relations relate also to the meaningfulness component.

The comprehensibility component may be influenced by consistent feedback at work, for example concerning the performance appraisal.

Salutogenics perspectives are also considered in the design of offices.

Wellbeing & Productivity

“Addressing wellbeing at work increases productivity by as much as 12%.” (Mental Health Foundation, 2021).

Reference

Mental Health Foundation. (2021) How to Support Mental Health at Work. Available from World Wide Web: https://www.mentalhealth.org.uk/publications/how-support-mental-health-work. [Accessed: 30 May, 2021].

Book: Psychology at Work

Book Title:

Psychology at Work.

Author(s): Peter Warr (Editor).

Year: 2002.

Edition: Fifth (5th), Revised Edition.

Publisher: Penguin.

Type(s): Paperback and Kindle.

Synopsis:

Applied psychology in work settings has made considerable progress in the 30 years since the original version of this book was published.

This new collection of essays aims to illustrate both the empirical and practical richness of the field as wellas its theoretical development.

The chapters cover psychological processes, the study of groups and workteams, and the nature of complex organisations as a whole.

Reflecting recent developments in psychology as well as society generally, topics range from skill and workload, shiftwork, personnel selection, training and careers, and the effects of new technology, leadership and management, to job stress and well-being, women in employment, corporate culture and processes of organisational change.

Book: Psychology in the Work Context

Book Title:

Psychology in the Work Context.

Author(s): Ziel Bergh and Dirk Geldenhuys.

Year: 2017.

Edition: Fifth (5th).

Publisher: Oxford University Press.

Type(s): Paperback.

Synopsis:

Psychology in the work context 5e is an introductory text for students of industrial and organizational psychology.

The book provides a comprehensive conceptual framework for understanding work behaviour and relationships at work and equips the student with a theoretical framework form which to analyse issues in the work place.

Book: Wellbeing at Work: How to Design, Implement and Evaluate an Effective Strategy

Book Title:

Wellbeing at Work: How to Design, Implement and Evaluate an Effective Strategy.

Author(s): Ian Hesketh and Cary Cooper.

Year: 2019.

Edition: First (1st).

Publisher: Kogan Page.

Type(s): Hardcover, Paperback and Kindle.

Synopsis:

Stress at work is rising year on year, long hours are becoming the norm and presenteeism is increasing across all industries. This is not only having a detrimental effect on employee health, happiness and productivity, but is also impacting the bottom line. HR professionals are uniquely placed to manage this modern workplace crisis by implementing a wellbeing strategy.

Wellbeing at Work is an essential, practical guide to designing and implementing an effective strategy that will reduce employee anxiety, increase staff engagement and improve overall performance.

Written by leading experts in the field, Wellbeing at Work takes readers through the entire process, from explaining why a wellbeing strategy is necessary in a fast-changing world of work and technological transformation to building momentum around it, and monitoring, measuring and evaluating its impact. The book also identifies common pitfalls and problems, and how to avoid them, explores important legislative considerations and provides example exercises and tools to use throughout the process.

Full of advice, tips and insights from real-world case studies, this is the only book you will need to create a happier, more productive and more profitable organisation

Book: Mental Wealth: An Essential Guide to Workplace Mental Health and Wellbeing

Book Title:

Mental Wealth: An Essential Guide to Workplace Mental Health and Wellbeing.

Author(s): Emi Golding and Peter Diaz.

Year: 2019.

Edition: First (1st).

Publisher: Morgan James Publishing.

Type(s): Paperback and Kindle.

Synopsis:

Mental Wealth reveals an approach to workplace mental health and wellbeing that is proven to actually get results.

Despite having a huge impact on the productivity, profitability, and culture of organizations, there is very little guidance currently provided to managers and leaders on how to effectively manage workplace mental health and wellbeing. What does exist is often focused on the legal aspects of minimizing risk that it misses the psychology of workplace mental health and high performance and actually ends up creating risk for workplaces.

Mental Wealth is a guide for managers and leaders on how to manage employees who may be experiencing mental health issues in the workplace. Founders of the Workplace Mental Health Institute, Peter Diaz and Emi Golding, provide an essential foundation for addressing workplace mental health. Some of the essential foundations discussed include dispelling myths about workplace mental health, the factors that cause and contribute to mental health issues, the impact those factors are having on workplaces, the benefits of addressing mental health appropriately, and 7 Pillars for a mentally Wealthy Workplace. Mental Wealth also includes case studies and practical strategies that can be implemented for immediate results.

Book: Mental Health and Wellbeing in the Workplace

Book Title:

Mental Health and Wellbeing in the Workplace: A Practical Guide for Employers and Employees.

Author(s): Gill Hasson and Donna Butler.

Year: 2020.

Edition: First (1st).

Publisher: Capstone.

Type(s): Paperback, Audiobook, and Kindle.

Synopsis:

Provides guidance for both employers and staff on promoting positive mental health and supporting those experiencing mental ill health in the workplace

The importance of good mental health and wellbeing in the workplace is a subject of increased public awareness and governmental attention. The Department of Health advises that one in four people will experience a mental health issue at some point in their lives. Although a number of recent developments and initiatives have raised the profile of this crucial issue, employers are experiencing challenges in promoting the mental health and wellbeing of their employees. Wellbeing & Mental Health in the Workplace contains expert guidance for improving mental health and supporting those experiencing mental ill health.

This comprehensive book addresses the range of issues surrounding mental health and wellbeing in work environments – providing all involved with informative and practical assistance. Authors Gill Hasson and Donna Butler examine changing workplace environment for improved wellbeing, shifting employer and employee attitudes on mental health, possible solutions to current and future challenges and more. Detailed, real-world case studies illustrate a variety of associated concerns from both employer and employee perspectives. This important guide:

  • Explains why understanding mental health important and its impact on businesses and employees.
  • Discusses why and how to promote mental health in the workplace and the importance of having an effective ‘wellbeing strategy’.
  • Provides guidance on managing staff experiencing mental ill health.
  • Addresses dealing with employee stress and anxiety.
  • Features resources for further support if experiencing mental health issues.

Wellbeing & Mental Health in the Workplace is a valuable resource for those in the workplace wanting to look after their physical and mental wellbeing, and those looking for guidance in managing staff with mental health issues.

Why is it Important to Identify Mental Health Problems among Employees in Physically Demanding Jobs?

Research Paper Title

Physical working conditions and subsequent disability retirement due to any cause, mental disorders and musculoskeletal diseases: does the risk vary by common mental disorders?

Background

Physical work exposures and common mental disorders (CMD) have been linked to increased risk of work disability, but their joint associations with disability retirement due to any cause, mental disorders or musculoskeletal diseases have not been examined.

Methods

The data for exposures and covariates were from the Finnish Helsinki Health Study occupational cohort surveys in 2000-2002, 2007 and 2012.

The researchers used 12,458 observations from 6159 employees, who were 40-60 years old at baseline.

CMD were measured by the General Health Questionnaire (GHQ-12, cut-off point 3+).

Four self-reported work exposures (hazardous exposures, physical workload, computer and shift work) were combined with CMD and categorized as “neither”, “work exposure only”, “CMD only”, and “both”.

Associations with register-based disability retirement were assessed with Cox proportional hazards models for sample survey data adjusting for confounders over 5-year follow-up.

Additionally, synergy indices were calculated for the combined effects.

Results

Those reporting CMD and high physical workload had a greater risk of disability retirement due to any cause (HR 4.26, 95% CI 3.60-5.03), mental disorders (HR 5.41, 95% CI 3.87-7.56), and musculoskeletal diseases (HR 4.46, 95% CI 3.49-5.71) when compared to those with neither.

Synergy indices indicated that these associations were synergistic.

Similar associations were observed for CMD and hazardous exposures, but not for combined exposures to CMD and computer or shift work.

Conclusions

Identification of mental health problems among employees in physically demanding jobs is important to support work ability and reduce the risk of premature exit from work due to disability.

Reference

Halonen J.I., Mänty, M., Pietiläinen, O., Kujanpää, T., Kanerva, N., Lahti, J., Lahelma, E., Rahkonen, O. & Lallukka, T. (2020) Physical working conditions and subsequent disability retirement due to any cause, mental disorders and musculoskeletal diseases: does the risk vary by common mental disorders? Social Psychiatry and Psychiatric Epidemiology. doi: 10.1007/s00127-019-01823-6. [Epub ahead of print].

Linking Risk of Suicidal Behaviour with Mental Disorders & Work Disability

Research Paper Title

Mental disorders and suicidal behavior in refugees and Swedish-born individuals: is the association affected by work disability?

Background

Among potential pathways to suicidal behavior in individuals with mental disorders (MD), work disability (WD) may play an important role.

The Researchers examined the role of WD in the relationship between MD and suicidal behaviour in Swedish-born individuals and refugees.

Methods

The study cohort consisted of 4,195,058 individuals aged 16-64, residing in Sweden in 2004-2005, whereof 163,160 refugees were followed during 2006-2013 with respect to suicidal behaviour.

Risk estimates were calculated as hazard ratios (HR) with 95% confidence intervals (CI).

The reference groups comprised individuals with neither MD nor WD.

WD factors (sickness absence (SA) and disability pension (DP)) were explored as potential modifiers and mediators.

Results

In both Swedish-born and refugees, SA and DP were associated with an elevated risk of suicide attempt regardless of MD. In refugees, HRs for suicide attempt in long-term SA ranged from 2.96 (95% CI: 2.14-4.09) (no MD) to 6.23 (95% CI: 3.21-12.08) (MD).

Similar associations were observed in Swedish-born. Elevated suicide attempt risks were also observed in DP.

In Swedish-born individuals, there was a synergy effect between MD, and SA and DP regarding suicidal behaviour.

Both SA and DP were found to mediate the studied associations in Swedish-born, but not in refugees.

Conclusions

There is an effect modification and a mediating effect between mental disorders and WD for subsequent suicidal behaviour in Swedish-born individuals.

Also for refugees without MD, WD is a risk factor for subsequent suicidal behaviour.

Particularly for Swedish-born individuals with MD, information on WD is vital in a clinical suicide risk assessment.

Reference

Björkenstam, E., Helgesson, M., Amin, R., Lange, T. & Mittendorfer-Rutz, E. (2020) Mental disorders and suicidal behavior in refugees and Swedish-born individuals: is the association affected by work disability? Social Psychiatry and Psychiatric Epidemiology. doi: 10.1007/s00127-019-01824-5. [Epub ahead of print].