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It has been postulated that poor mental health can lead to disability and disability can lead to unemployment. However, the association between poor mental health and employment status among adults with disabilities has not been well characterized in population-based studies.To examine the association between employment status and frequent mental distress (FMD; 14 or more mentally unhealthy days during the previous 30 days) among adults with disabilities.Cross-sectional data were analysed for 47 377 community-dwelling US adults aged 25–64 years with disabilities that participated in the 2001 and 2003 Behavioural Risk Factor Surveillance System. Logistic regression analysis was applied.Among adults with disabilities, the unadjusted prevalence of FMD was 18% (SE 0.4) among those employed, 40% (SE 1.3) among those unemployed and 44% (SE 0.8) among those unable to work. After adjustments were made for age, sex and race/ethnicity, the results indicated that adults with disabilities who were unemployed or unable to work were significantly more likely than those employed to have FMD (adjusted prevalence: 39 and 45%, respectively, versus 18%; P < 0.001). These associations persisted after further adjusting for education, marital status, health risk behaviours, body mass index, health care coverage and self-rated general health (34 and 36%, respectively, versus 19%; P < 0.001).These findings demonstrate the need for research and development of public health interventions to reduce the toll of mental distress among all adults with disabilities.