Occurrence of mental illness and mental health risks among the self-employed: A systematic review

Willeke K, Janson P, Zink K, Stupp C, Kittel-Schneider S, Berghöfer A, Ewert T, King R, Heuschmann PU, Zapf A, Wildner M, Keil T (2021)

Publication Type: Journal article, Review article

Publication year: 2021

Journal

International Journal of Environmental Research and Public Health Multidisciplinary Digital Publishing Institute (MDPI)

Book Volume: 18

Article Number: 8617

Journal Issue: 16

DOI: 10.3390/ijerph18168617

Abstract

We aimed to systematically identify and evaluate all studies of good quality that compared the occurrence of mental disorders in the self-employed versus employees. Adhering to the Cochrane guidelines, we conducted a systematic review and searched three major medical data-bases (MEDLINE, Web of Science, Embase), complemented by hand search. We included 26 (three longitudinal and 23 cross-sectional) population-based studies of good quality (using a validated quality assessment tool), with data from 3,128,877 participants in total. The longest of these studies, a Swedish national register evaluation with 25 years follow-up, showed a higher incidence of mental illness among the self-employed compared to white-collar workers, but a lower incidence compared to blue-collar workers. In the second longitudinal study from Sweden the self-employed had a lower incidence of mental illness compared to both blue-and white-collar workers over 15 years, whereas the third longitudinal study (South Korea) did not find a difference regarding the incidence of depressive symptoms over 6 years. Results from the cross-sectional studies showed associations between self-employment and poor general mental health and stress, but were inconsistent regarding other mental outcomes. Most studies from South Korea found a higher prevalence of mental disorders among the self-employed compared to employees, whereas the results of cross-sectional studies from outside Asia were less consistent. In conclusion, we found evidence from population-based studies for a link between self-employment and increased risk of mental illness. Further longitudinal studies are needed examining the potential risk for the development of mental disorders in specific subtypes of the self-employed.

Involved external institutions

Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit (LGL) DE Germany (DE) Universitätsklinikum Würzburg DE Germany (DE) Charité - Universitätsmedizin Berlin DE Germany (DE) Julius-Maximilians-Universität Würzburg DE Germany (DE) Bayerisches Staatsministerium für Umwelt und Verbraucherschutz / Bavarian State Ministry of the Environment and Consumer Protection DE Germany (DE)

How to cite

APA:

Willeke, K., Janson, P., Zink, K., Stupp, C., Kittel-Schneider, S., Berghöfer, A.,... Keil, T. (2021). Occurrence of mental illness and mental health risks among the self-employed: A systematic review. International Journal of Environmental Research and Public Health, 18(16). https://doi.org/10.3390/ijerph18168617

MLA:

Willeke, Kristina, et al. "Occurrence of mental illness and mental health risks among the self-employed: A systematic review." International Journal of Environmental Research and Public Health 18.16 (2021).

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