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A new study published in Science Direct looked at how different dimensions of precarious employment affects mental health.

“This is a study that analyzes the relationship between job insecurity and mental health in a Spanish territory (the Basque Country),” study author Erika Valero told us. “Prior to the start of the study, we carried out a systematic review on the subject, available in the International Journal of occupational medicine and environmental health, in which we identified numerous publications in the European context that highlighted the impact of job insecurity on mental health during the last decades, using different types of indicators for measuring insecurity. Therefore, and considering the importance of paid work as a social determinant of health, we expected that also in our context, this problem could be related to mental health.”

In line with the idea outlined above, researchers have long known that paid work is an important social determinant of health. It should be borne in mind that most populations and families depend on the livelihoods they derive from the sale of their labour power. Moreover, work is not only the main means of subsistence in most societies, but is also an important source of personal development and identity. Along with these premises, researchers also considered that work is one of the activities in which working people spend most of their time.

“All of this, as I explained at the beginning, means that paid work, its characteristics, its contractual basis and the conditions in which it is carried out strongly affect the quality of life and the health of individuals and families,” Valero told us. “Our research team is dedicated to the study of social inequalities in health and the social determinants of health. In this sense, and considering that in Spain job insecurity is more widespread than in other European countries and wage levels are lower, we understood that it was important to address this issue.”

For the study, researchers used the 2018 Basque Country Health Survey, a survey that is carried out every four years and with which they are very familiar as they have used it for numerous studies. The particularity of the 2018 edition is that it included for the first time a reduced version of a multidimensional scale to measure job insecurity (EPRES-Employment precariousness scale), designed by a Catalan research team with a long tradition in the study of job insecurity and its impact on health.

“For our study, we considered the salaried population aged 16 to 65 years (with a total sample of 3345 cases), using statistical models to measure the relationship between job insecurity in general and mental health, as well as each of the dimensions that make up this scale separately to try to identify whether some dimensions were more closely related to worse mental health outcomes,” Valero told us.

Mental health was measured using a validated instrument, the MHI-5, which identifies the presence of symptoms of anxiety and depression. In addition, all analyses were stratified by sex, given the importance of analyzing the problem from a gender-sensitive perspective.

“To begin with, we found that in general, both men and women in high job insecurity were more than three times more likely to suffer from symptoms of anxiety or depression than those who did not experience job insecurity,” Valero told us. “Moreover, the relationship between job insecurity and mental health was maintained, even when adjusting the statistical models for other variables such as educational attainment or socio-economic status.”

This means that, even neutralizing the effect of the latter factors, job insecurity still seems to negatively affect workers' mental health. On the other hand, researchers found that some dimensions seemed to have a greater impact on the health of precarious workers, such as wage level or vulnerability, measured through indicators that identify the fear experienced by workers of being exposed to reprisals for demanding better working conditions or the feeling of helplessness in the face of unfair treatment by employers.

“In view of the available scientific evidence, we assumed that in our context, job insecurity would also be related to worse mental health indicators,” Valero told us. “However, we found that the likelihood of suffering from anxiety or depression among precarious workers was indeed high.”

Moreover, these odds remained significantly high even when neutralizing the effects of other socio-economic position variables, which confirms what was previously said about the centrality of paid employment. The results also highlight the need to pay special attention to some dimensions of precarious work, such as wage level and vulnerability, in order to combat this problem.

“In our context, it has been very common for political discourse and measures to focus on the problem of unemployment, and it is only in recent years that we have also begun to concern ourselves with job insecurity,” Valero told us. Of course, it is essential to facilitate access to the labour market but also to ensure that employment conditions and wage levels are decent. We live in complex systems, but we know that, in general, societies have achieved a great capacity to generate wealth, which means that the means exist to ensure that everyone has a decent quality of life.”

In terms of employment, Valero explained that this means that governments and companies must protect working people, ensure that they carry out their work in a safe environment, and that this activity allows them access to the essential goods for a dignified life. Some formulas to achieve these objectives could include raising minimum wages, increasing labour inspections to ensure compliance with labour rights and regulations, trade union advocacy and support for vulnerable workers, especially in sectors where there is little unionization.

“The idea that health in general, and mental health in particular, is a state that does not depend solely on the biological or genetic characteristics of human beings, but that, in addition to lifestyles, it is strongly conditioned by the social environments in which people live and develop,” Valero told us. “These environments can favour the maintenance of optimal health but can also constitute an important risk to it. Thus, together with social class, gender, environmental characteristics or housing conditions, among many other social factors, work is an essential aspect to take into account when assessing people's possibilities or opportunities to enjoy a better or worse state of health. In short, let us be aware that improving the health of individuals and peoples cannot depend solely on guaranteeing access to quality health systems, but also on favouring healthy social environments capable of offering opportunities for the development of a dignified life.”