Mental Health Problems of Self-Employed Workers: A Systematic Review of Potential Moderators

PURPOSE

This systematic review aims to summarize the mental health outcomes of self-employment and identify potential moderators between self-employment and mental health issues, ultimately guiding future research and informing targeted suggestions for future practice.

METHOD

The initial search identified 3412 publications, including 43 that met the inclusion criteria. We identified 20 potential moderators in total.

RESULTS

According to the summary results based on the diathesis-stress model, gender, financial precarity, and social security were identified as the most frequent potential moderators in each domain.

DISCUSSION

The systematic review highlights the complex relationship between self-employment and mental health, revealing that self-employment often correlates with negative mental health outcomes such as stress and depression. Future practice should prioritize financial stability strategies, gender-specific support initiatives, work-life balance improvements, and expanded social security protections for self-employed workers.

Flourish, fight or flight: health in self-employment over time-associations with individual and business resources

PURPOSE

Using COR theory to study developments of health and other key resources in self-employed workers in Sweden over 6 years, this study: (1) explored whether the heterogenous group of self-employed workers contained subgroups with different health trajectories, (2) investigated whether these were more typical for certain individuals (with respect to age, gender, sector, education, employment status), and (3) compared the different health trajectories regarding resource development in mental well-being, business resources, employment status, work ability.

METHOD

The study used data from the Swedish longitudinal occupational survey of health (SLOSH) and included participants working as self-employed or combiner (N = 2642).

RESULT

Five trajectories were identified with latent class growth curve model analysis (LCGM). Two health trajectories with (1) very good, respective (2) good stable health (together comprising 78.5% of the participants), (3) one with moderate stable health (14.8%), (4) one with a U-shaped form (1.9%), and (5) one with low, slightly increasing health (4.7%). The first two trajectories flourish: they maintained or increased in all key resources and were more likely to remain self-employed. Trajectories three and five consist of those who fight to maintain or increase their resources. Workers in the U-shaped health trajectory show signs of fight and flight after loss in health and other key resources.

CONCLUSIONS

Studying subgroups with different resource developments over time was suitable to understand heterogeneity in self-employed workers. It also helped to identify vulnerable groups that may benefit from interventions to preserve their resources.

Multiple social roles in early adulthood and later mental health in different labour market contexts

Work and family roles entail divergent responsibilities, which can be a source of conflict especially in young adulthood - the so-called "rush-hour" of life. Combining these multiple social roles can result in an accumulation of stress but also be a valuable resource for mental health. The aim of this study is to investigate combined employment, parenthood and partnership trajectories of men and women during early adulthood, and to analyse the relationship of these multiple roles with depressive symptoms at older age. We used harmonised data from the Survey of Health, Ageing and Retirement in Europe (SHARE) and the English Longitudinal Study of Ageing (ELSA) with retrospective information on employment, partnerships and parenthood histories between age 25 and 40 for 18,816 men and 24,686 women (n = 43,502). We applied sequence analysis and clustering to group trajectories into four clusters for women and three clusters for men. We then used multilevel models to analyse the links between combined employment and family roles and later mental health in different historical labour market contexts (indicated by female employment rates). Women and men who did not combine work and family roles between age 25 and 40 report higher levels of depression than those who combined work and family. Results differ by gender and labour market context, with stronger differences between women in countries with higher female employment rates. Overall, combining multiple roles in early adulthood is associated with decreased rather than increased risk for depressive symptoms in older Europeans.

Use of outpatient medical care by headache patients in Germany: a population-based cross-sectional study

Background

Headache sufferers in need of professional health care often do not utilize the care available, and factors influencing headache-specific physician consultation are not yet understood. Objectives of this study are (1) to assess self-reported headache-specific physician consultations and (2) to identify headache-related and sociodemographic predictors.

Methods

Data of a random sample of the general population in Germany aged ≥14 years were analyzed (N = 2461). A multivariate binary logistic regression was conducted to identify a parsimonious model to predict physician consultation.

Results

50.7% of the participants with headache reported at least one headache-specific physician consultation during lifetime. Of these, 53.6% had seen one, 26.1% two, and 20.3% more than two physicians because of their headaches. The odds of physician consultation increased with the number of headache days per month (HDM) [(reference HDM < 1) HDM 1–3 (OR = 2.29), HDM 4–14 (OR = 2.41), and HDM ≥15 (OR = 4.83)] and increasing Headache Impact Test score (HIT-6) [(reference “no or little impact”) moderate impact (OR = 1.74), substantial impact (OR = 3.01), and severe impact (OR = 5.08)]. Middle-aged participants were more likely to have consulted than younger and older ones [(reference 14–34 years) 35–54 years (OR = 1.90), 55–74 years (OR = 1.96), ≥75 years (OR = 1.02)]. The odds of physician consultation among self-employed subjects were lower than among employed manual workers (OR = 0.48). The living environment (rural versus urban) did not have an influence on the consultation frequency.

Conclusion

The results indicate that apart from burden-related factors (headache frequency; headache impact), health care utilization patterns are also influenced by patients’ occupational status and age. Further research is needed to analyze whether the lower consultation rate means that the self-employed have a higher risk of chronification or that they have more effective self-management strategies regarding headache.

Is Female Entrepreneurship Only Empowering for Single Women? Evidence from France and Germany

Entrepreneurship has been suggested as an alternative career model for women to gain economic empowerment while maintaining caring obligations. In this study, we investigate how gender and living situation affect entrepreneurs’ engagement in their business, home, well-being and business success in both France and Germany. Data from the European Social Survey were used, which included 470 French and 622 German self-employed people. For the French, women reported more working hours when living alone but there were no gender differences for the other living situations. For the Germans, there were no gender differences when the self-employed person lived alone; for the other living situations, men reported more working hours. Women reported working more household hours than men in both countries. There were no gender differences in life satisfaction for German self-employed people regardless of living situation; for the French, gender differences varied by living situation. Men reported more business success than women in both countries. Results suggest that self-employed people in Germany follow a traditional breadwinner model, whereas in France, self-employed women do more paid and unpaid work at the same time. In sum, entrepreneurship may only be empowering for self-employed women living alone.

How to Divide Paid Work and Unpaid Care between Parents? Comparison of Attitudes in 22 Western Countries

Sharing responsibilities for paid work and unpaid care between men and women is recognised as one of the challenges that Western countries face in the 21st century. This article examines attitudes towards sharing paid work and unpaid care responsibilities in 22 Western countries by addressing the following questions. (1) How do attitudes towards different earner-carer models vary across countries? (2) Which socio-demographic and country-level factors explain differences in attitudes to an equal division of paid work and unpaid care responsibilities? International Social Survey Programme (ISSP) data 2012 is used as the data source and research methods include logistic multi-level regression analysis. Results reveal that cross-national variations in attitudes are significant: Most traditional attitudes are found in many Eastern European countries, whereas Nordic countries are the least traditional. At the individual level, those who are highly educated, in paid work, single, childless, and religiously non-active support the equal division of paid work and unpaid care responsibilities more often than other respondents. At the country level, longer father-specific parental leave, a stronger tradition of women’s paid work, and less traditional gender roles are related to stronger support for an equal division of paid work and unpaid care.