Precarious employment and mental health in Europe : Development, validation, and association with mental health of a novel cross-national measure

This dissertation aims to advance knowledge on the contours of precarious employment (PE) as a social determinant of health by developing, validating, and evaluating the association with mental health of a novel measure of PE in Europe. A multidimensional summative scale conceptually grounded on the Employment Precariousness Scale (EPRES) was built drawing on the European Working Conditions Survey-2015. Such scale, (namely, EPRES-E) consists of 13 items sorted into six dimensions (temporariness, vulnerability, disempowerment, exercise of rights, wages, and unpredictability of working times). The proposed structure proved to be valid first in Spain and, thereafter, in Austria, Belgium, Croatia, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Lithuania, Luxembourg, the Netherlands, Norway, Poland, Portugal, Slovakia, Slovenia, Sweden, Switzerland and the UK. Accordingly, the role of welfare states in the relationship between EPRES-E and poor mental health was tested in these countries, both among women and men. Consistent associations were found in all genders and welfare states analyzed. Besides, Central-Eastern welfare states were found to aggravate the abovementioned relationship among women, compared to their counterparts in continental welfare states. No differences were found among men, though.Aquesta tesi té com a objectiu avançar en el coneixement sobre la configuració de la precarietat laboral (PL) com a determinant social de la salut desenvolupant, validant i avaluant l'associació amb salut mental d'una nova mesura de PL a Europa. Es va construir una escala sumativa multidimensional basada conceptualment en l'Escala de Precarietat Laboral (EPRES) a partir de l'Enquesta Europea de Condicions de Treball-2015. Aquesta escala, (és a dir, EPRES-E) consta de 13 ítems ordenats en sis dimensions (temporalitat, vulnerabilitat, desapoderament, exercici de drets, salaris, i imprevisibilitat dels temps de treball). L'estructura proposada va demostrar ser vàlida primer a Espanya i, després, a Àustria, Bèlgica, Croàcia, Dinamarca, Finlàndia, França, Alemanya, Grècia, Irlanda, Itàlia, Lituània, Luxemburg, Països Baixos, Noruega, Polònia, Portugal, Eslovàquia, Eslovènia, Suècia, Suïssa i el Regne Unit. En conseqüència, es va analitzar el paper dels estats del benestar en la relació entre la EPRES-E i la mala salut mental en aquests països, tant en dones com homes. Es van trobar associacions consistents en tots els gèneres i estats del benestar analitzats. A més, es va trobar que els estats del benestar del centre-est accentuaven la relació esmentada entre les dones, en comparació amb les seves homòlogues dels estats del benestar continentals. No es van trobar diferències entre els homes, però

Comparing precarious employment across countries – measurement invariance of the employment precariousness scale for Europe

Comparing precarious employment (PE) across countries is essential to deepen the understanding of the phenomenon and to learn from country-specific experiences. However, this is hampered by the lack of internationally meaningful measures of PE. We aim to address this point by assessing the measurement invariance (MI) of the Employment Precariousness Scale for Europe (EPRES-E), an adaptation of the EPRES construct in the European Working Conditions Survey (EWCS). EPRES-E consists of 13 proxy-indicators sorted into six dimensions: temporariness, disempowerment, vulnerability, wages, exercise of rights, unpredictable working times. Drawing on EWCS-2015, MI of the second-order factor model was tested in a sample of 31,340 formal employees by means of (a) multi-group confirmatory factor analyses, and (b) the substantive exploration of EPRES-E mean scores in each country. The results demonstrate that threshold invariance holds for the first-order structure (dimensions) of 22 countries (Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Lithuania, Luxembourg, the Netherlands, Norway, Poland, Portugal, Slovakia, Slovenia, Spain, Sweden, Switzerland, UK), but only metric invariance is attained by the second-order structure. The latter is supported by the exploration of mean scores, where we found that different score patterns in each dimension lead to similar overall EPRES-E scores, suggesting that PE is configured by different sources within the six dimensions in each country according to their broader socio-political trajectories. We conclude that, although EPRES-E can be used for comparative purposes in 22 European countries, the scores of each dimension must be reported alongside the overall EPRES-E score.The research leading to these results has been supported by the Spanish Ministry of Science, Innovation and Universities under grant agreements No. CSO2016-79103R and No. CSO2017-89719-R (AEI/FEDER, UE)

Non-standard employment and unemployment during the COVID-19 crisis: economic and health findings from a six-country survey study

The COVID-19 crisis is a global event that has created and amplified social inequalities, including an already existing and steadily increasing problem of employment and income insecurity and erosion of workplace rights, affecting workers globally. The aim of this exploratory study was to review employment-related determinants of health and health protection during the pandemic, or more specifically, to examine several links between non-standard employment, unemployment, economic, health, and safety outcomes during the COVID-19 pandemic in Sweden, Belgium, Spain, Canada, the United States, and Chile, based on an online survey conducted from November 2020 to June 2021. The study focused on both non-standard workers and unemployed workers and examined worker outcomes in the context of current type and duration of employment arrangements, as well as employment transitions triggered by the COVID-19 crisis. The results suggest that COVID-19-related changes in non-standard worker employment arrangements, or unemployment, are related to changes in work hours, income, and benefits, as well as the self-reported prevalence of suffering from severe to extreme anxiety or depression. The results also suggest a link between worker type, duration of employment arrangements, or unemployment, and the ability to cover regular expenses during the pandemic. Additionally, the findings indicate that the type and duration of employment arrangements are related to the provision of personal protective equipment or other COVID-19 protection measures. This study provides additional evidence that workers in non-standard employment and the unemployed have experienced numerous and complex adverse effects of the pandemic and require additional protection through tailored pandemic responses and recovery strategies

Experiences of insecurity among non-standard workers across different welfare states: A qualitative cross-country study

In recent decades, economic crises and political reforms focused on employment flexibilization have increased the use of non-standard employment (NSE). National political and economic contexts determine how employers interact with labour and how the state interacts with labour markets and manages social welfare policies. These factors influence the prevalence of NSE and the level of employment insecurity it creates, but the extent to which a country's policy context mitigates the health influences of NSE is unclear. This study describes how workers experience insecurities created by NSE, and how this influences their health and well-being, in countries with different welfare states: Belgium, Canada, Chile, Spain, Sweden, and the United States. Interviews with 250 workers in NSE were analysed using a multiple-case study approach. Workers in all countries experienced multiple insecurities (e.g., income and employment insecurity) and relational tension with employers/clients, with negative health and well-being influences, in ways that were shaped by social inequalities (e.g., related to family support or immigration status). Welfare state differences were reflected in the level of workers' exclusion from social protections, the time scale of their insecurity (threatening daily survival or longer-term life planning), and their ability to derive a sense of control from NSE. Workers in Belgium, Sweden, and Spain, countries with more generous welfare states, navigated these insecurities with greater success and with less influence on health and well-being. Findings contribute to our understanding of the health and well-being influences of NSE across different welfare regimes and suggest the need in all six countries for stronger state responses to NSE. Increased investment in universal and more equal rights and benefits in NSE could reduce the widening gap between standard and NSE

Precarious employment and mental health across European welfare states: a gender perspective

Objective: The aim of this article was to examine the relationship between precarious employment (PE), welfare states (WS) and mental health in Europe from a gender perspective. Methods: Data were derived from the European Working Conditions Survey 2015. PE was measured through the Employment Precariousness Scale for Europe (EPRES-E), validated for comparative research in 22 European countries, and categorized into quartiles. Countries were classified into Continental, Anglo-Saxon, Scandinavian, Southern and Central-Eastern WS. Mental health was assessed through the WHO-5 Well-Being Index and dichotomized into poor and good mental health. In a sample of 22,555 formal employees, we performed gender-stratified multi-level logistic regression models. Results: Results showed greater prevalences of PE and poor mental health among women. However, the association between them was stronger among men. Cross-country differences were observed in multi-level regressions, but the interaction effect of WS was only significant among women. More precisely, Central-Eastern WS enhanced the likelihood of poor mental health among women in high precarious employment situations (quartiles 3 and 4). Conclusions: These findings suggest the interaction between contextual and individual factors in the production of mental health inequalities, both within and across countries. They also call for the incorporation of gender-sensitive welfare policies if equitable and healthy labor markets are to be achieved in Europe

COVID-19 and precarious employment: consequences of the evolving crisis

The world of work is facing an ongoing pandemic and an economic downturn with severe effects worldwide. Workers trapped in precarious employment (PE), both formal and informal, are among those most affected by the COVID-19 pandemic. Here we call attention to at least 5 critical ways that the consequences of the crisis among workers in PE will be felt globally: (a) PE will increase, (b) workers in PE will become more precarious, (c) workers in PE will face unemployment without being officially laid off, (d) workers in PE will be exposed to serious stressors and dramatic life changes that may lead to a rise in diseases of despair, and (e) PE might be a factor in deterring the control of or in generating new COVID19 outbreaks. We conclude that what we really need is a new social contract, where the work of all workers is recognized and protected with adequate job contracts, employment security, and social protection in a new economy, both during and after the COVID-19 crisis

Unequal access? Use of sickness absence benefits by precariously employed workers with common mental disorders: a register-based cohort study in Sweden

Objective: This study compares the use of sickness absence benefits (SABs) due to a common mental disorder (CMD) between precariously employed and non-precariously employed workers with CMDs. Design: Register-based cohort study. Participants: The study included 78 215 Swedish workers aged 27-61 who experienced CMDs in 2017, indicated by a new treatment with selective serotonin reuptake inhibitors (SSRIs). Excluded were those who emigrated or immigrated, were self-employed, had an annual employment-based income 90 days of unemployment per year, had student status, had SABs due to CMDs during the exposure measurement (2016) and the two previous years, had an SSRI prescription 1 year or less before the start of the SSRI prescription in 2017, had packs of >100 pills of SSRI medication, had a disability pension before 2017, were not entitled to SABs due to CMDs in 2016, and had no information about the exposure. Outcome: The first incidence of SABs due to CMDs in 2017. Results: The use of SABs due to a CMD was slightly lower among precariously employed workers compared with those in standard employment (adjusted OR [aOR] 0.92, 95% CI 0.81 to 1.05). Particularly, women with three consecutive years in precarious employment had reduced SABs use (aOR 0.48, 95% CI 0.26 to 0.89), while men in precarious employment showed weaker evidence of association. Those in standard employment with high income also showed a lower use of SABs (aOR 0.74, 95% CI 0.67 to 0.81). Low unionisation and both low and high-income levels were associated with lower use of SABs, particularly among women. Conclusions: The study indicates that workers with CMDs in precarious employment may use SABs to a lower extent. Accordingly, there is a need for (1) guaranteeing access to SABs for people in precarious employment and/or (2) reducing involuntary forms of presenteeism