The 10^th of October is World Mental Health Day and this year’s theme stresses that good mental health should be a human right for all. Currently, this is sadly far from reality. Globally, depression is one of the leading causes of years lived with disability. Data from the 2014 Adult Psychiatric Morbidity Survey suggests that 1 in 6 adults aged 16 and over in England had suffered from a common mental health condition (such as anxiety and depression) in the week prior to the survey.

Mental health conditions may be a barrier to work. The Office for National Statistics estimates that ‘depression, anxiety and bad nerves’ are the most common health conditions among individuals who are economically inactive due to long-term sickness in 2023 in the UK. The prevalence of these conditions has increased in this group since pre-pandemic, and the majority reported them as a secondary (not main) health condition. This reminds us of the fact that mental and physical health conditions can also co-occur.

Mental health conditions are, however, not equally distributed across society. The 2010 Marmot review of health inequalities in England gathered strong evidence to show that our social conditions and social position have influence on our mental and physical health. Unemployment is, for example, often associated with poorer mental health compared to having a job. A subsequent review also suggested that health inequalities have further widened in the decade that followed this review.

What is also increasingly clear, however, is that mental health inequalities are also present amongst those in work. The quality of jobs and employment have implications for workers’ mental health and wellbeing. Our team here at IER recently undertook a scoping review on job quality and health. Looking at dimensions of job quality, we identified systematic reviews and meta-reviews on associations with health outcomes. We found that considerable evidence has been published, for instance, on the psychosocial work environment and its links to workers’ health. One systematic review found evidence to suggest that those exposed to a source of workplace stress, job strain (high job demands and low job control) were at increased risk of depression. Other aspects of job and employment quality, including job insecurity, have also been linked to adverse mental health, as has decreasing income. Some, but not all, evidence, links long working hours to depression (what constitutes ‘long’ working hours can also differ).

Work-related ‘risk factors’ of course, may not act independently but might ‘cluster’ together. In other words, some workers may face multiple adverse work and employment aspects. This underpins what we know on the mental health disadvantage facing those in precarious employment. While many may associate it with temporary or zero-hours contracts, it has been suggested that, also from a health perspective, precarious employment is best understood as low-quality employment – characterised by amongst others, insecurity, low pay and lack of rights, which can go hand in together. Precarious employment has been linked to poorer mental health and wellbeing in several studies. Those in precarious forms of employment may experience more psychosocial stress and their lower income can lead to material deprivation which in turn can lead to adverse mental health consequences.

Individuals, of course, can and do move from job to job, from unemployment into employment, and vice versa. Our research has highlighted that not only is the quality of employment an emerging health determinant, but the quality of employment trajectories is also linked to one’s mental health. Using Belgian administrative data, our paper suggested that those whose trajectory was characterised by higher instability and lower income had greatly elevated rates of mental health-related disability in the years that followed than did those with a more stable trajectory and better income. Prolonged unemployment was also associated with a mental health disadvantage, as were some other trajectories. This suggests that not only is it important to create high-quality employment, and improve precarious employment, but that it is also necessary to ensure that employees can retain good jobs and high-quality employment over a period of time. This can also entail supporting those with existing (mental) health conditions at the workplace.

In sum, to narrow the mental health gap, and in the spirit of this year’s World Mental Health Day, to guarantee the right to good mental health for all, we do need to consider the quality of jobs and of employment.

Rebeka Balogh, EUTOPIA PhD student at the Vrije Universiteit Brussel (Belgium) and the IER