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

Kristina Willeke, Patrick Janson, Katharina Zink, Carolin Stupp, Sarah Kittel-Schneider, Anne Berghöfer, Thomas Ewert, Ryan King, Peter U. Heuschmann, Andreas Zapf, Manfred Wildner and Thomas Keil
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Kristina Willeke: State Institute of Health, Bavarian Health and Food Safety Authority, 91058 Erlangen, Germany
Patrick Janson: State Institute of Health, Bavarian Health and Food Safety Authority, 91058 Erlangen, 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
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
Andreas Zapf: Bavarian State Ministry of the Environment and Consumer Protection, 81925 Munich, Germany
Manfred Wildner: State Institute of Health, Bavarian Health and Food Safety Authority, 91058 Erlangen, Germany
Thomas Keil: State Institute of Health, Bavarian Health and Food Safety Authority, 91058 Erlangen, Germany

IJERPH, 2021, vol. 18, issue 16, 1-25

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.

Keywords: incidence; mental disorders; mental health; mental illness; prevalence; self-employed; small business; systematic review (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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