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Occurrence of Mental Illness and Mental Health Risks among the Self-Employed: A Systematic Review

Author

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  • Kristina Willeke

    (State Institute of Health, Bavarian Health and Food Safety Authority, 91058 Erlangen, Germany
    Institute of Clinical Epidemiology and Biometry, University of Würzburg, 97070 Würzburg, Germany)

  • Patrick Janson

    (State Institute of Health, Bavarian Health and Food Safety Authority, 91058 Erlangen, Germany
    Institute of Clinical Epidemiology and Biometry, University of Würzburg, 97070 Würzburg, Germany)

  • Katharina Zink

    (State Institute of Health, Bavarian Health and Food Safety Authority, 91058 Erlangen, Germany)

  • Carolin Stupp

    (State Institute of Health, Bavarian Health and Food Safety Authority, 91058 Erlangen, Germany
    Institute of Clinical Epidemiology and Biometry, University of Würzburg, 97070 Würzburg, Germany)

  • Sarah Kittel-Schneider

    (Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital Würzburg, 97080 Würzburg, Germany)

  • Anne Berghöfer

    (Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany)

  • Thomas Ewert

    (State Institute of Health, Bavarian Health and Food Safety Authority, 91058 Erlangen, Germany)

  • Ryan King

    (Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany)

  • Peter U. Heuschmann

    (Institute of Clinical Epidemiology and Biometry, University of Würzburg, 97070 Würzburg, Germany
    Clinical Trial Center Würzburg, University Hospital Würzburg, 97080 Würzburg, Germany)

  • Andreas Zapf

    (Bavarian State Ministry of the Environment and Consumer Protection, 81925 Munich, Germany
    Pettenkofer School of Public Health, University of Munich, 81377 Munich, Germany)

  • Manfred Wildner

    (State Institute of Health, Bavarian Health and Food Safety Authority, 91058 Erlangen, Germany
    Pettenkofer School of Public Health, University of Munich, 81377 Munich, Germany)

  • Thomas Keil

    (State Institute of Health, Bavarian Health and Food Safety Authority, 91058 Erlangen, Germany
    Institute of Clinical Epidemiology and Biometry, University of Würzburg, 97070 Würzburg, Germany
    Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany)

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 databases (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.

Suggested Citation

  • Kristina Willeke & Patrick Janson & Katharina Zink & Carolin Stupp & Sarah Kittel-Schneider & Anne Berghöfer & Thomas Ewert & Ryan King & Peter U. Heuschmann & Andreas Zapf & Manfred Wildner & Thomas , 2021. "Occurrence of Mental Illness and Mental Health Risks among the Self-Employed: A Systematic Review," IJERPH, MDPI, vol. 18(16), pages 1-25, August.
    • Handle: RePEc:gam:jijerp:v:18:y:2021:i:16:p:8617-:d:614786
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    References listed on IDEAS

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