Objective This study aimed to investigate the hypothesis that negative status incongruence may contribute to explain higher risk of mental ill-health and sickness absence in human service occupations (HSO).

Methods Participants from the Swedish Longitudinal Occupational Survey of Health who responded to questionnaires in both 2014 and 2016 (N=11 814; 42% men, 58% women) were included. Status incongruence between register-based educational level and subjective social status was assessed. The association between employment in a HSO and status incongruence was estimated in linear regression analyses adjusted for age, income, work hours, sickness absence, childcare, and job qualification match. The prospective associations between status incongruence and mild-to-severe depressive symptoms and register-based sickness absence >= 31 days respectively were estimated with logistic regression analyses in models adjusted for age and outcomes at baseline. All analyses were stratified by gender.

Results Employment in a HSO was associated with more negative status incongruence in both genders [standardized coefficient men 0.04, 95% confidence interval (CI) 0.02-0.07; women 0.06, 95% CI 0.04-0.09]. More negative status incongruence was furthermore associated with higher odds of mild-to-severe depressive symptoms (men OR 1.18, 95% CI 1.08-1.29; women OR 1.17, 95% CI 1.09-1.26) and sickness absence >= 31 days (men OR 1.40, 95% CI 1.23-1.59; women OR 1.17, 95% CI 1.07-1.28) two years later.

Conclusion Status incongruence is somewhat higher among HSO than other occupations and associated with increased odds of depressive symptoms and sickness absence.