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

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.

Analysis of self-reported mental health problems among the self-employed compared with paid workers in the Republic of Korea

“… 36 A study that used a systematic analysis of mental health problems encountered by self-employed workers showed inconsistent results in several studies, while cross-sectional studies in the United States, Australia, and Europe showed lower or similar prevalence estimates for self-employed workers compared with paid workers. 37 However, although cross-sectional research is limited, the prevalence rate of mental problems among self-employed workers in Korea was higher than that of paid workers, which was consistent with our results.…”

Lifetime Employment Trajectories and Cancer: A Population-Based Cohort Study

“…Self-employed people may generally have better health compared to employees for the following reasons: firstly, self-employed men may have more control over their work environment and workload, and therefore be better able to manage the stress levels; secondly, self-employed men may have more flexibility in their working hours, which may allow them to engage in healthy behaviours such as exercise and healthy eating, or cancer screening. On the other hand, we cannot ignore that the self-employed are exposed to the risks and responsibilities that come with running a business, which can lead to stress 97 , 98 , thus limiting the proposed explanation.…”

The Predominance of the Health-Promoting Patterns of Work Behavior and Experience in General Practice Teams—Results of the IMPROVEjob Study

“…Therefore, they often face longer working hours, greater work-family conflict, and higher work stress than employees [68]. A recent systematic review also discovered hints of a link between self-employment and increased risk of mental illness [69].…”