Employment Precariousness and Poor Mental Health: Evidence from Spain on a New Social Determinant of Health

Background. Evidence on the health-damaging effects of precarious employment is limited by the use of one-dimensional approaches focused on employment instability. This study assesses the association between precarious employment and poor mental health using the multidimensional Employment Precariousness Scale. Methods. Cross-sectional study of 5679 temporary and permanent workers from the population-based Psychosocial Factors Survey was carried out in 2004-2005 in Spain. Poor mental health was defined as SF-36 mental health scores below the 25th percentile of the Spanish reference for each respondent’s sex and age. Prevalence proportion ratios (PPRs) of poor mental health across quintiles of employment precariousness (reference: 1st quintile) were calculated with log-binomial regressions, separately for women and men. Results. Crude PPRs showed a gradient association with poor mental health and remained generally unchanged after adjustments for age, immigrant status, socioeconomic position, and previous unemployment. Fully adjusted PPRs for the 5th quintile were 2.54 (95% CI: 1.95–3.31) for women and 2.23 (95% CI: 1.86–2.68) for men. Conclusion. The study finds a gradient association between employment precariousness and poor mental health, which was somewhat stronger among women, suggesting an interaction with gender-related power asymmetries. Further research is needed to strengthen the epidemiological evidence base and to inform labour market policy-making. 1. Introduction Precarious employment and unemployment, key social determinants of health [1], affect numerous workers in developed and developing countries [2], warranting concern among public health researchers. But, while there is solid evidence of the adverse effects of job loss on health [2], and despite the rapid increase of precarious employment over the past three decades, research on its health effects is limited by the lack of an appropriate measurement instrument to assess precarious employment [3]. During good part of the 20th century, precarious employment in industrialized countries was confined to minority worker subpopulations [4]. Today, it has expanded with the shift undertaken by these countries towards more flexible labour arrangements [2, 5, 6] and the resulting decline of the “standard” employment relationship (full-time, permanent jobs with benefits) that became the norm in the decades following WWII [2]. Precarious employment has been defined in terms of the erosion of the “standard” employment relationship as an employment situation that involves instability, low wages,