Job precariousness and mental health in the Basque Country: An intersectional mediation analysis

Background

Research has shown an association of job precariousness with mental health, especially among migrants and those with manual occupations but with mixed results by gender. Moreover, evidence from an intersectional perspective is scarce. We aimed to analyse intersectional inequalities in poor mental health and the role of job precariousness in the Basque Country, Spain.

Methods

We selected salaried employees in the working age population (i.e., aged 18-64) from the Basque Health Survey (ESCAV) in 2018 and 2023 (n=4,704). Mental health (poor/good) was measured using the Mental Health Inventory-5. Job precariousness (yes/no) was measured using the simplified version of the EPRES scale. Eight intersectional strata were created by the combination of gender (men/women), social class (manual/non-manual) and migration status (native/immigrant). We conducted an intersectional mediation analysis to estimate poor mental health inequalities as prevalences differences (PD) compared to non-manual native men, and the mediation of job precariousness by differential exposure and differential vulnerability, controlling for age, survey year, marital status, social support and perceived discrimination.

Results

Compared with non-manual native men, poorer mental health was only observed among manual native women (PD = 8.70pp; 95%CI=5.11-12.28pp). Job precariousness contributed to poorer mental health due to differential higher exposure in manual migrant women (1.26pp; 0.31-2.21pp) and men (0.69pp; 0.13-1.25pp) and manual native women (0.47pp; 0.10-0.84pp) and due to differential higher vulnerability in manual migrant women (1.11pp, 0.34-1.88pp).

Conclusions

Among intersectional groups, poorer mental health was only observed among manual native women. However, job precariousness mediated a detrimental impact on mental health of manual migrant men and women by higher prevalences, and manual native women by both higher prevalence of and higher vulnerability to precariousness.

Key messages

• Intersectional inequalities in poor mental health were partly mediated by higher prevalences of job precariousness among manual worker migrants as well as manual worker native women.

• Public health measures should ensure adequate working conditions to promote mental health, especially for migrants and women in manual occupations.