Qualitative evidence on the relationships between precarious employment and mental health in western economies: a scoping review protocol
Creators: name: Irvine, Annie
Publisher: name: Open Science Framework
Year: 2022
Subjects: subject: Family, Life Course, and Society
subject: Work, Economy and Organizations
subject: Medicine and Health
subject: Social and Behavioral Sciences
subject: Sociology
subject: FOS: Sociology
subject: precarious employment

description: SCOPING REVIEW PROTOCOL BACKGROUND In recent decades, the concept of ‘precarious employment’ has received increasing attention both in sociological and social policy arenas (1-6). Whilst there is currently no single agreed definition of precarious employment, there is consensus that it is a multidimensional concept, with core components of employment insecurity, income inadequacy and lack of rights and protection (1, 7-9). The notion of precarious work overlaps to a large extent with the concept of ‘non-standard’ work; non-standard in that it differs from the ‘standard employment relationship’ of full-time, stable and socially protected employment with a single employer (10). In deviating from this ‘standard’ (i), non-standard forms of work are characterised by temporariness, inconsistency or unpredictability in working hours, and associated uncertainties in income. These combine to a status of precariousness for the worker, who may find themselves with insufficient economic resources, leading to material and social deprivation. Some conceptualisations of precarious work go further to include poor workplace social support, lack of access to training and development, higher exposure to occupational health hazards, and low work status (12). This array of factors has been associated with adverse mental health effects on those in precarious employment situations (13, 14). Systematic reviews have found consistent correlations between perceived job insecurity and poor mental health (15-18). There is also a large body of evidence showing a relationship between insecure forms of employment, such as temporary jobs, zero-hours contracts and ‘gig’ work, and negative mental health outcomes (18-25). Such insecure work arrangements make up a growing proportion of employment across many western economies (26-29) (ii) and are disproportionately occupied by women, minority ethnic, immigrant, younger, lower socioeconomic status, and lower educated workers (32-36), hence their potential detriment to mental health is of significant social policy and public health concern. However, evidence for the association between insecure work and mental health is inconsistent (16, 37-39). Research has shown that a number of contextual variables, including gender, age, education and household structures, can mediate the relationship between insecure employment and mental health (24, 37, 40-44), and these pathways and mechanisms are as yet not fully understood (5, 18). Furthermore, objectively insecure employment forms are not unequivocally detrimental. Some people may choose non-standard work for the benefits of flexibility, work-life balance and scope to pursue broader life goals (45-51), and whilst there is a substantial overlap between low paid, low skilled and insecure employment (27), some forms of non-standard employment are highly remunerative. As described by Tompa et al (12), precarious employment is a ‘person-in-context’ phenomenon, with the potential effects on mental health modified or magnified by that context (51). Qualitative research is thus essential in illuminating the situated and nuanced experience of precarious employment, offering insights into the complex and contingent relationships between employment status, mental health and broader social wellbeing. The purpose of this review is to bring together qualitative research evidence on the lived experience of precarious employment as it pertains to mental health, as a foundation for further empirical study within a broader research programme on societal change and mental health (iii) . This review is especially timely as sectors already characterised by more insecure employment forms, such as accommodation, hospitality, leisure and retail (35, 52), are those being hit hardest by the economic fallout of the Covid-19 pandemic. As such, workers in these sectors, among whom women, young people and minority ethnic groups are overrepresented (26, 33, 34, 53), find themselves at enhanced risk of job insecurity, reduced income and consequent negative mental health impacts (54-56). This review will shed light on lived experiences of precarious employment, in particular the pathways and mechanisms connecting precarious work and adverse mental health effects. It will thus enable the identification of important empirical research questions and potential policy interventions for the post-Covid economic and public health landscape. Acknowledging the heterogeneity of current and historic employment structures and trends at the global scale (3), the review is focused on western economies, namely the UK and Europe, USA, Canada and Australasia. To our knowledge, no similar scoping reviews are published or under way. Searches carried out on 1st October 2020 in a number of registries/journals (PROSPERO, JBI systematic review register, JBI Evidence Synthesis Journal, Campbell Collaboration Database, Campbell Systematic Reviews Journal, BMC systematic reviews journal, FigShare, Open Science Framework) identified ten registered protocols involving some focus on precarious employment and mental health. None of these are considered to be duplicative of the present protocol, because they either exclude qualitative studies, focus on specific populations (e.g. migrants, farmers), look at implemented interventions rather than lived experience, or focus on presenteeism rather than mental health outcomes. METHODS The aim of this scoping review is to provide a narrative synthesis of qualitative research evidence on the associations between precarious employment and mental health, drawn from empirical studies conducted in western economies over the past 40 years. We define this study as a scoping review (as opposed to systematic review) because our aim is to explore the breadth of extant research on a set of broadly defined concepts, with a view to mapping conceptualisations, empirical themes and identifying knowledge gaps (57, 58). We have followed JBI guidance in developing this protocol and the review will be reported in accordance with the PRISMA-ScR (59). REVIEW QUESTIONS • What is known from qualitative research about the relationships between precarious employment and mental health in western economies? • What pathways, mediators and mechanisms lead to these relationships between precarious employment and mental health? • How do these relationships (and their pathways etc.) differ according to demographic variables (e.g. gender, age, ethnicity, impairment/disability) and other biographical features (e.g. parenthood, partnership, education level, career aspirations)? INCLUSION CRITERIA Participants: The primary population of interest is adults of working age (iv), of all genders and ethnicities. Studies addressing the lived experiences of the families (partners, children, parents) of precariously employed adults will also be eligible for inclusion. Study participants may include individuals with no history of mental health difficulties and/or individuals who self-identify or are professionally diagnosed as having mental health difficulties (independent of any exposure to precarious employment). Concepts: &gt;Precarious employment: We will include studies that use a broad or multidimensional definition of precarious employment as their framing concept, and will also include studies that take a unidimensional approach examining one of the following: temporary employment, zero-hours, part-time, gig work, platform work, agency work. We do not directly explore self-employment but will include studies that explore the concept of ‘bogus self-employment’ within one of the aforementioned employment forms. &gt;Mental health: We will take a broad and non-prescriptive conceptualisation of mental health. Search terms have been set to capture a spectrum of psychological experiences, including clinically specified common mental health problems (depression, anxiety) as well as stress and concepts of subjective wellbeing and life satisfaction. Context: The review is limited geographically to developed western economies (the UK, Europe, USA, Canada and Australasia). This is in recognition of the relevance of specific labour market and social welfare policy contexts in shaping employment experiences, and the review’s purpose of informing follow-on empirical research based in the UK only. As such, we have restricted geography to countries where there are most areas of similarity (recognising that there are also many areas of difference, e.g. healthcare funding and unemployment benefit systems). Search parameters will be set from 1980 to present day, on the basis that the term precarious employment first began to appear in academic social policy literature in the late 1980s and only in any significant volumes from 2000 onward (9, 31). We will not limit searches on the basis of language (60) and will consider key papers in any European language. Study type and method: We will include primary research studies using any type of qualitative method e.g. interviews, focus groups, diary methods, visual methods, social media derived data, ethnography, participant observation. Qualitative strands of mixed-methods studies will be included. Eligible document types include peer-reviewed academic publications, research conducted by charities, think tanks, campaign groups, government-commissioned studies, doctoral theses, conference papers (where sufficient information is available). Outcomes: The primary outcome of interest is mental health/mental wellbeing broadly defined. We will examine the studies for findings on any aspect of mental health including: clinically diagnosed mental health conditions (e.g. depression, anxiety, PTSD, phobias), self-defined experiences of psychological distress (e.g. anxiety, depression, stress, low-mood, sadness, worry), and social or interpersonal difficulties (e.g. relationship stress or breakdown). We are also interested in mental health/mental wellbeing outcomes for family members (partners, children, parents). The study will not look specifically at physical health outcomes, but in recognition of the interplay of psychological distress and physical health complaints, any reported findings will be noted and discussed. Search strategy: The overarching research programme which will be informed by this review is focused primarily on lived experiences of precarious work within the UK labour market and social security system. Hence, we have configured a search strategy which captures the main forms of precarious employment that are prominent in the contemporary UK labour market and national social policy discourse (v). As a scoping review, we will keep search terms continuously under review, taking an iterative approach to the search strategy as and when additional terms emerge as relevant. Any revisions will be comprehensively documented for transparency. Concept Synonyms: 1a) Precariousness temporary; part-time, part time, parttime; agency; gig; fixed-term, fixed term; non-standard, nonstandard, non standard; non-permanent, nonpermanent; atypical, a-typical; contingent; platform; portal; short term, short-term; zero hours, zero-hours; flexible; alternative; casual; intermittent; informal; irregular; precari*; insecure; unstable; peripher* 1b) Insecurity job insecurity; employment insecurity; work insecurity 2) Employment job*; employment; work; contract*; occupation*; labour; economy 3) Mental health mental health; mental wellbeing, mental well-being; mental illness; wellbeing, well-being; psycho*; psychological health, psychological well(-)being, psychosocial health, psychosocial well(-)being; depression; anxiety; stress; distress; lived experience Search strings will be configured of: [1] (OR searches of synonym group 1a) AND (OR searches of synonym group 2) [2] OR searches of synonym group 1b [3] OR searches of synonym group 3 [4] Combination of [1] + [3] [5] Combination of [2] + [3] Sources of evidence: We will search the following electronic databases: • ProQuest: ASSIA, IBSS, Sociological Abstracts • OVID: PsychInfo, Social Policy and Practice, EMBASE • Web of Science • Scopus • Grey literature: WorldCat (theses), ProQuest (theses), Social Science Research Network We will interrogate the references lists of included documents for further studies reflecting our topic of interest, and these will be sourced and screen in the same way described below. Citation searches will also be used. We will search the Internet for additional grey literature (e.g. research reports from thinktanks and campaigning organisations) as well as browsing key organisations’ websites. Studies will be screened using title and abstract, supported by Rayyan online software (vi). As resources available to the review do not permit dual-screening of all studies, title and abstract screening will be carried out by one researcher. Full texts will be sourced for all studies passing this initial screening process. One reviewer will read all full texts and assess against inclusion criteria. A second reviewer will check 20% of full texts to establish consistency in decision-making. In cases of disagreement, a third researcher will be consulted and decisions reached by consensus. Data extraction: Data extraction will be carried out by one researcher, with 10% of papers checked by a second researcher for consistency of approach. An extraction template will be used, with provisional headings including: • Lead author (+ commissioning organisation where relevant), year of publication • Title • Type of publication • Country/ies of data collection • Study aims and objectives • Stated research questions • Conceptualisation of precarious employment (stated a priori) • Method (data collection, analysis, timeperiod of study) • Participants (n, characteristics) • Participant employment context/employment status • Conceptualisations of precarious employment (emergent from data) • Main thematic findings on subjective experiences of precarious employment and mental health • Any other notable findings • Proposed mechanisms/pathways between precarious employment and mental health • Main conclusions • Research implications (author stated) • Policy implications (author stated) • Limitations (author stated) • Quality appraisal (reviewer assessed) The extraction template will be piloted with 5 studies, during which template headings will be revised according to the content of included papers. The template will be kept under continual review, revised as appropriate and any papers already extracted will be returned to for a second iteration, whenever additional extraction categories are added. Quality assessment/risk of bias: In line with scoping review methodology (57, 59), studies will not be ranked or excluded on the basis of quality assessment, but the CASP qualitative checklist (62) will be used to appraise each study’s methodological conduct, and consideration will be given to positionality and impartiality of reported findings where research has been produced by thinktanks or campaigning organisations. Analysis: Narrative analysis will be conducted on the results of included studies, following the method described by Popay et al (63). Analysis of the qualitative thematic findings of the included studies will be supported using MaxQDA software (vii). We will synthesise the main findings on the question of how lived experience of precarious employment affects mental health of the individual and (where discussed) their family and wider social network. We will consider the qualitative evidence (where information is available) along comparative dimensions of gender, age, household, disability and country, as well as other variables that emerge as salient from within the included literature. Where possible, analysis will reflect on the role of different countries’ welfare state regimes, in shaping lived experiences of precarious work (64). We will examine the data for evidence of pathways and mechanisms between precarious employment and mental health, both those explicitly proposed by study authors and those that emerge from consideration of the data set as a whole. However, we will not attempt a formal qualitative meta-synthesis due to the broad, scoping approach of this review. Findings of the narrative analysis may point to more specific questions that can be addressed through a subsequent qualitative meta-synthesis. Presentation of results: Results will be presented narratively, accompanied by a table of major themes and sub-themes emerging from analysis of qualitative findings from the included studies. An overview of descriptive variables of the included studies (country, method, participants, etc.) will also be produced. DISCUSSION Limitations: Resource constraints lead us to place some limits on the breadth and comprehensiveness of this review. In particular, we do not include self-employment among the search terms. We recognise that ‘bogus self-employment’ is an important concept within debates on precarious work, but for present purposes rely on terms such as ‘gig’ and ‘casual’ work leading us to relevant empirical studies that encompass bogus or involuntary self-employment. Resource constraints also mean that it will not be possible to dual screen every retrieved item. Whilst recognising best practice of dual screening (65), we note that this is achieved by only a minority of scoping reviews (66), and is not always deemed necessary even for systematic reviews (67). We will also (in the first instance) only be able to fully extract items published in English, Spanish, French, German, Dutch and Italian. However, searches will not be limited by language and any relevant papers in other languages will be kept on file for a later iteration of the review, should resources become available. Methodological challenges: We are aware of a methodological challenge inherent in our focus on the qualitative pathways and mechanisms connecting the lived experience of precarious work and mental health. Namely, these pathways traverse effects on family, social relationships, housing and material wellbeing, reflecting a broader notion of ‘precarious lives’ (30, 33, 68-76). We anticipate that the impacts of precarious work on family, social relations, housing, etc. are likely to have been the primary focus of much qualitative research in this area, with (consequent) mental health effects embedded within studies’ discussion, rather than as a priori research questions that could be easily identified via title/abstract searches. Our search strategy will thus need to be iterative and err on the side of inclusion, in order to identify materials that provide an holistic account of lived experiences of precarious employment and mental health. Consultation and dissemination: Drafts of this protocol have been informally reviewed by academic peers with a range of disciplinary and methodological backgrounds, and the review design will be discussed in a workshop with mental health service users and representatives of third sector organisations working in the mental health and employment support field (December 2020). 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Sarıtaş CT. Precarious contours of work–family conflict: The case of nurses in Turkey. The Economic and Labour Relations Review. 2020;31(1):59-75. 76. Smith A, McBride J. ‘Working to Live, Not Living to Work’: Low-Paid Multiple Employment and Work–Life Articulation. Work, Employment and Society.0(0):0950017020942645. ENDNOTES (i) We acknowledge here that the concept of the Standard Employment Relationship grew out of a rather narrowly perceived, western, white and male-dominated experience of work, and overlooks the experiences of women, minority ethnic groups and indeed much of the global population (1. Kalleberg AL, Vallas SP. Probing Precarious Work: Theory, Research, and Politics. In: Arne LK, Steven PV, Arne LK, Steven PV, editors. Precarious Work. Research in the Sociology of Work. 31: Emerald Publishing Limited; 2017. p. 1-30, 3. ILO. Non-standard employment around the world: Understanding challenges, shaping prospects. Geneva: International Labour Organisation; 2016, 11. Vosko LF. Temporary Work : The Gendered Rise of a Precarious Employment Relationship. Toronto: University of Toronto Press; 2000.) (ii) Despite a general perception that non-standard employment is on the increase, there is a ‘significant minority view’ (30. Lewchuk W. Precarious jobs: Where are they, and how do they affect well-being? The Economic and Labour Relations Review. 2017;28(3):402-19.) that trends in employment forms have not actually changed very much; increases in temporary and part-time work have been modest, and gig work still accounts for a very small minority of employment. For overviews see (30. Ibid., 1. Kalleberg AL, Vallas SP. Probing Precarious Work: Theory, Research, and Politics. In: Arne LK, Steven PV, Arne LK, Steven PV, editors. Precarious Work. Research in the Sociology of Work. 31: Emerald Publishing Limited; 2017. p. 1-30.) and for a UK analysis see (31. Choonara J. The Precarious Concept of Precarity. Review of Radical Political Economics. 2020;52(3):427-46.) (iii) The ESRC Centre for Society and Mental Health: https://www.kcl.ac.uk/csmh/about (iv) This may differ slightly according to country but will be in the region of 15-67 years. (v) We note that other recent systematic reviews (18. Utzet M, Valero E, Mosquera I, Martin U. Employment precariousness and mental health, understanding a complex reality: a systematic review. International Journal of Occupational Medicine and Environmental Health. 2020;33(5):569-98, 61. Ornek OK, Weinmann T, Waibel J, Radon K. Precarious employment and migrant workers’ mental health: a protocol for a systematic review of observational studies. Systematic Reviews. 2020;9(1):50.) use a much more extensive set of search terms, incorporating a number of more diverse dimensions of precarious employment. However, based on the above stated rationale, the following terms (which are found in the aforementioned reviews) are not included in our search strategy: downsizing, redundancy, organisational change, privatisation, outsourcing, unionisation, collective bargaining, worker/workplace rights, employee voice, involvement, overtime, inconvenient hours, worktime control, self-employment (vi) https://rayyan.qcri.org/welcome (vii) https://www.maxqda.com/