Qualitative evidence on the relationships between precarious employment and mental health in western economies: a scoping review protocol

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: >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. >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 me

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