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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. Occurrence of Mental Illness and Mental Health Risks among the Self-Employed: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8617. [PMID: 34444369 PMCID: PMC8393630 DOI: 10.3390/ijerph18168617] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 11/17/2022]
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.
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Affiliation(s)
- Kristina Willeke
- State Institute of Health, Bavarian Health and Food Safety Authority, 91058 Erlangen, Germany; (P.J.); (K.Z.); (C.S.); (T.E.); (M.W.); (T.K.)
- 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; (P.J.); (K.Z.); (C.S.); (T.E.); (M.W.); (T.K.)
- 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; (P.J.); (K.Z.); (C.S.); (T.E.); (M.W.); (T.K.)
| | - Carolin Stupp
- State Institute of Health, Bavarian Health and Food Safety Authority, 91058 Erlangen, Germany; (P.J.); (K.Z.); (C.S.); (T.E.); (M.W.); (T.K.)
- 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; (A.B.); (R.K.)
| | - Thomas Ewert
- State Institute of Health, Bavarian Health and Food Safety Authority, 91058 Erlangen, Germany; (P.J.); (K.Z.); (C.S.); (T.E.); (M.W.); (T.K.)
| | - Ryan King
- Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany; (A.B.); (R.K.)
| | - 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; (P.J.); (K.Z.); (C.S.); (T.E.); (M.W.); (T.K.)
- 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; (P.J.); (K.Z.); (C.S.); (T.E.); (M.W.); (T.K.)
- 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; (A.B.); (R.K.)
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