Gesundheitswesen 2022; 84(08/09): 764-765
DOI: 10.1055/s-0042-1753714
Abstracts | DGSMP/DGMS
Vorträge
Thema: Arbeit und Gesundheit

Comparing the Occurrence of Mental and Physical Disorders in Self-employed Individuals with that of Employees: a Systematic Review

K Willeke
1   Bavarian Health and Food Safety Authority, State Institute of Health, Erlangen, Deutschland
2   University of Würzburg, Institute of Clinical Epidemiology and Biometry, Würzburg, Deutschland
,
P Janson
1   Bavarian Health and Food Safety Authority, State Institute of Health, Erlangen, Deutschland
2   University of Würzburg, Institute of Clinical Epidemiology and Biometry, Würzburg, Deutschland
,
K Zink
1   Bavarian Health and Food Safety Authority, State Institute of Health, Erlangen, Deutschland
,
C Stupp
1   Bavarian Health and Food Safety Authority, State Institute of Health, Erlangen, Deutschland
2   University of Würzburg, Institute of Clinical Epidemiology and Biometry, Würzburg, Deutschland
,
C Tischer
3   Department of Health Security, Finnish Institue of Health and Welfare, Kuopio, Finnland
,
S Kittel-Schneider
4   University Hospital Würzburg, Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Würzburg, Deutschland
,
A Berghöfer
5   Charité – Universitätsmedizin Berlin, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Deutschland
,
T Ewert
1   Bavarian Health and Food Safety Authority, State Institute of Health, Erlangen, Deutschland
,
R King
5   Charité – Universitätsmedizin Berlin, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Deutschland
,
PU Heuschmann
2   University of Würzburg, Institute of Clinical Epidemiology and Biometry, Würzburg, Deutschland
6   University Hospital Würzburg, Clinical Trial Center Wuerzburg, Würzburg, Deutschland
,
A Zapf
7   Bavarian State Ministry of the Environment and Consumer Protection, Munich, Deutschland
8   University of Munich, Pettenkofer School of Public Health, Munich, Deutschland
,
M Wildner
1   Bavarian Health and Food Safety Authority, State Institute of Health, Erlangen, Deutschland
8   University of Munich, Pettenkofer School of Public Health, Munich, Deutschland
,
T Keil
1   Bavarian Health and Food Safety Authority, State Institute of Health, Erlangen, Deutschland
2   University of Würzburg, Institute of Clinical Epidemiology and Biometry, Würzburg, Deutschland
5   Charité – Universitätsmedizin Berlin, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Deutschland
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Einleitung A stringent systematic review of population-based observational studies focusing on the health of self-employed individuals as a basis for the development of targeted prevention strategies is lacking. Therefore, we aimed to evaluate systematically all the studies of good quality that compared the occurrence of mental or physical disorders in self-employed individuals with that of employees.

Methoden Adhering to the Cochrane guidelines, we conducted two systematic reviews (one on mental and the other on physical health outcomes) and searched three major medical databases (MEDLINE, Web of Science, Embase), which was complemented by a hand search up to March 2020, with an update on 7 April 2021. The quality of the studies was rated independently by two reviewers based on the slightly modified validated assessment tool by Hoy et al. The interrater agreement was high.

Ergebnisse We included 42 (nine longitudinal and 33 cross-sectional) population-based studies of good quality, with data from 18,498,241 participants in total.

The longest two evaluations both from Sweden (over 15 and 25 years) showed a lower incidence of mental illness among self-employed individuals compared to blue-collar workers, whereas the incidence compared to white-collar workers was higher in one and lower in the other study. Longitudinal evaluations on physical health outcomes showed both increased cardiovascular mortality (over 12 years) and incidence estimates of cardiovascular disease (over 23 years) in self-employed individuals compared with those of white-collar employees but decreased risk estimates compared with those of blue-collar workers. The only longitudinal study that examined arthrosis of the hip showed a higher hospitalization rate for self-employed individuals compared with that of employees.

Results from the cross-sectional studies of these systematic reviews showed associations between self-employment and poor general mental health and stress. Furthermore, they showed that prevalence estimates for musculoskeletal, respiratory and malignant diseases were higher among self-employed individuals than among employees. The prevalence of hypertension, diabetes, headache and eyestrain was not consistently associated with employment status.

Schlussfolgerun We found evidence from population-based studies for a link between self-employment and increased risk of mental and physical disorders. As a basis for targeted prevention strategies, further longitudinal studies in different settings are required to better understand the development of chronic disorders for specific self-employment categories such as sole proprietors, small entrepreneurs and family businesses.



Publication History

Article published online:
22 August 2022

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