Be gman, Louise E.; Bujacz, Aleksand a; Leinewebe , Cons anze; Toi anen,
Susanna; Be nha d-Oe el, Claudia
A icle
A e you in o a e you ou ? A longi udinal pe son-
cen e ed s udy o heal h and en ance and exi in o sel -
employmen
BRQ Business Resea ch Qua e ly
P o ided in Coope a ion wi h:
Asociación Cien í ica de Economía y Di ección de Emp esas (ACEDE), Mad id
Sugges ed Ci a ion: Be gman, Louise E.; Bujacz, Aleksand a; Leinewebe , Cons anze; Toi anen,
Susanna; Be nha d-Oe el, Claudia (2025) : A e you in o a e you ou ? A longi udinal pe son-
cen e ed s udy o heal h and en ance and exi in o sel -employmen , BRQ Business Resea ch
Qua e ly, ISSN 2340-9444, Sage Publishing, London, Vol. 28, Iss. 3, pp. 678-694,
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Despi e being a smalle segmen o he wo k o ce
(Ekonomi ak a, 2023), sel -employed wo ke s make sig-
ni ican con ibu ions o ou socie y in e ms o economic
p oduc i i y, job oppo uni ies, and inno a ion (Van P aag
& Ve sloo , 2007). Howe e , many wo ke s who en e
sel -employmen lea e again, and his may ha e de imen-
al e ec s o he indi idual (Nikolo a e al., 2021). Thus,
a c ucial a ea o esea ch in he ield o sel -employmen
e ol es a ound unde s anding he ac o s ha in luence
indi iduals en e ing and exi ing sel -employmen .
An impo an aspec o keeping a business unning is
he heal h o he sel -employed wo ke , as esea ch indi-
ca es ha his is ela ed o he success and su i al o hei
businesses (Koch e al., 2021). I is well documen ed
ha —on a e age—sel -employed wo ke s expe ience be -
e heal h compa ed o employed wo ke s (S ephan, 2018).
Howe e , sel -employed wo ke s comp ise a highly
di e se g oup when i comes o who hey a e, how hey
wo k, and hei heal h (Be nha d-Oe el e al., 2024).
Fu he mo e, heal h is a complex cons uc , and depending
on how heal h is assessed, esul s may a y (S ephan e al.,
2023). The e o e, s udying sel -employed wo ke s as one,
homogeneous g oup and elying on a e ages om single
aspec s o heal h is insu icien o p o ide esea che s,
policymake s, and o ganiza ions wi h a comp ehensi e
A e you in o a e you ou ? A longi udinal
pe son-cen e ed s udy o heal h and
en ance and exi in o sel -employmen
Louise E. Be gman1, Aleksand a Bujacz2, Cons anze Leinewebe 1,
Susanna Toi anen3 and Claudia Be nha d-Oe el1
Abs ac
This s udy add esses he sca ci y o esea ch on heal h de elopmen s in he he e ogeneous g oup o sel -employed
wo ke s. I aims a unde s anding ypical heal h p og essions in his g oup and associa ions wi h demog aphic ac o s,
wo k cha ac e is ics, and sel -employmen decisions. We in es iga e heal h p o iles based on men al heal h p oblems,
sel - a ed heal h, and wo k sa is ac ion, as well as ansi ions be ween hem in ela ion o wo k e o , ewa d,
o e commi men , demog aphic cha ac e is ics, and en ance and exi in o sel -employmen . Using la en ansi ion
analysis, we analyzed da a om he Swedish Longi udinal Occupa ional Su ey o Heal h (SLOSH), including da a om
593 pa icipan s. We iden i ied ou dis inc , s able heal h p o iles, e ealing associa ions wi h wo k e o , ewa d,
o e commi men , and sel -employmen decisions. No meaning ul ela ions exis ed o demog aphic cha ac e is ics.
O e all, he indings o e a comp ehensi e pe spec i e on he heal h dynamics o sel -employed indi iduals, hei
associa ions wi h wo k cha ac e is ics and decisions o en e and exi sel -employmen .
JEL CLASSIFICATION: J62; J81; L26
Keywo ds
Sel -employmen , men al heal h, pe son-cen e ed analysis, e o ewa d model, en ep eneu ship
1 Sec ion o Wo k and O ganiza ional Psychology, Depa men o
Psychology, S ockholm Uni e si y, S ockholm, Sweden
2 Depa men o Lea ning, In o ma ics, Managemen and E hics,
Ka olinska Ins i u e , S ockholm, Sweden
3 The School o heal h, ca e and social wel a e, Mäla dalen Uni e si y,
Väs e ås, Sweden
Co esponding au ho :
Louise E. Be gman, Sec ion o wo k and o ganiza ional psychology,
Depa men o Psychology, S ockholm Uni e si y, S ockholm 106 91,
Sweden.
Email: [email p o ec ed]
1277831BRQ0010.1177/23409444241277831Business Resea ch Qua e lyBe gman e al.
esea ch-a icle2024
Special Issue: En ep eneu ship and
Well-Being: Resea ch P og ess and Challenges Ahead
Be gman e al. 679
unde s anding o heal h de elopmen in his speci ic g oup
o wo ke s in ela ion o hei demog aphic and wo k cha -
ac e is ics, and en ance and exi in o sel -employmen .
Al hough he e is exis ing esea ch o en ance and exi
o sel -employmen , ew s udies ake a longi udinal
app oach wi h scien i ic igo , ollowing indi iduals in and
ou o sel -employmen , and e en ewe examine he
e ec s on a ious aspec s o heal h (Gish, Le ne , e al.,
2022). In his s udy, we aim o shed ligh on he de elop-
men o heal h in ela ion o sel -employmen , demo-
g aphic and wo k cha ac e is ics, and decisions o en e o
exis sel -employmen . In doing so, we make se e al
impo an con ibu ions o he li e a u e. Fi s , since heal h
may di e in he he e ogeneous g oup o wo ke s ha
en e , exi , o emain in sel -employmen o e a pe iod o
4 yea s, we will iden i y subg oups based on heal h p o-
iles and s udy how wo ke s change be ween hese p o iles
o e ime. Fu he mo e, we aim o inc ease unde s anding
o he link be ween heal h de elopmen s and decisions o
en e , s ay in, o exi sel -employmen , and he e o e, we
in es iga e how en ance in o and exi ou o sel -employ-
men a ec heal h. In addi ion o his, we will also in es i-
ga e how hese de elopmen s associa e wi h demog aphic
and wo k cha ac e is ics. We s udy wo k cha ac e is ics
h ough he lens o he e o ewa d imbalance (ERI)
model (Sieg is e al., 1986), which explain he ela ion-
ship be ween wo k and heal h by he e o s a wo ke pu
in o wo k and he ewa ds ecei ed. I he e is a balance,
his is bene icial o wo ke ’s heal h, whe eas imbalances
in wo k e o s and ewa ds cons i u e h ea s o heal h.
This adds o bo h he heo e ical unde s anding o he
di e si y in sel -employmen conce ning heal h de elop-
men s and decisions o s a o emain in his employmen
o m. The analysis o indi idual and wo k cha ac e is ics
also p o ides insigh s o p ac ical signi icance because i
may help o iden i y ulne able g oups o which in e en-
ions may be needed o imp o e possibili ies o se up and
un businesses success ully.
Sel -employmen
Sel -employed wo ke s engage in an ac i i y o hei own
accoun and a e able o ec ui hei own employees (Eu opean
Union Founda ion, 2009). O e ime, wo ke s may change
be ween employmen o ms—sel -employmen and o gani-
za ional employmen —o wo k in bo h, e e ed o as being a
combine (Be gman e al., 2021) o hyb id en ep eneu
(Fol a e al., 2010). Thus, i is impo an no o s udy only
wo ke s ha a e s ably sel -employed bu also hose who
en e and exi sel -employmen . While sel -employed wo k-
e s a e o en e e ed o as en ep eneu s, i is a e m ha mo e
accu a ely desc ibes indi iduals who become sel -employed
due o ha ing an idea o inno a ion bu excludes hose who
en e sel -employmen ou o necessi y. Thus, o his s udy,
we will use he e m sel -employed wo ke s.
Sel -employmen g an s eedom o o ganize wo k
acco ding o own p e e ences, a ec ing a ious aspec s o
wo k, including ask selec ion, ime scheduling, and skill
de elopmen (Obschonka & Silbe eisen, 2015). Howe e ,
alongside he eedom ha comes wi h sel -employmen ,
challenges such as po en ial income es ic ions, blu ed
bounda ies be ween wo k and pe sonal li e, lack o pee
suppo , and esponsibili y o employees may a ise
(S ephan, 2018). One o he ew s udies ocusing on a i-
ous aspec s o heal h in sel -employed wo ke s, indica e
ha sel -employed wo ke s expe ience bo h happiness and
nega i e eelings, and mo e heal h p oblems han employed
wo ke s (Bencsik & Chuluun, 2021). Thus, he idea ha
sel -employmen has an en i ely posi i e ela ionship wi h
heal h does no seem o hold ue, wa an ing a close look
in o men al heal h o sel -employed wo ke s.
Sel -employmen and illbeing in e ms o
men al heal h p oblems
Men al heal h o sel -employed wo ke s has hus a mos
p e alen ly been s udied h ough he absence o men al
heal h p oblems such as s ess, emo ional exhaus ion,
dep essi e symp oms, and sleep dis u bances (S ephan,
2018), which may be de ined as illbeing.
S ess is a nonspeci ic pe cei ed esponse o demands
(Åke s ed e al., 2015). Ex an esea ch shows ha wo ke s
eel s essed when hey expe ience wo k si ua ions wi h an
imbalance be ween pe cei ed e o s pu in o wo k and
ewa ds ecei ed (Sieg is e al., 1986). I his exposu e is
epea ed, wi hou allowing he wo ke eco e y be ween
s ess ul pe iods, s ess can become a ch onic expe ience.
Consequen ly, he indi idual may su e om heal h p ob-
lems such as emo ional exhaus ion (Åke s ed e al., 2016).
Emo ional exhaus ion is a s a e cha ac e ized by o p o-
ound a igue and deple ion, and a sense o being bu ned
ou (Melamed e al., 1992; Shi om, 1989; Shi om &
Melamed, 2006). Emo ional exhaus ion is a se ious and
common p oblem in he wo k o ce. S udies sugges ha
sel -employed wo ke s may be pa icula ly ulne able o i ,
due o hei unique wo k ci cums ances (McDowell e al.,
2019). Fu he mo e, emo ional exhaus ion may d i e in en-
ion o exi sel -employmen (Sa deshmukh e al., 2021).
Dep essi e symp oms a e ano he common men al
heal h p oblem in he wo king o ce. These encompass a
b oad ange o emo ional, cogni i e, and physical symp-
oms, including eelings o sadness, low ene gy le els,
lack o in e es , and excessi e wo ying (Magnusson
Hanson e al., 2014). I is impo an o no e ha emo ional
exhaus ion and dep essi e symp oms can co-occu . Sel -
employed wo ke s may be sensi i e o dep essi e symp-
oms because hey o en lack he social suppo ha
o ganisa ionally employed wo ke s bene i om and may
ha e a endency o in e nalize emo ions due o s igma and
ea o ailu e (Cubbon e al., 2021).
680 Business Resea ch Qua e ly 28(3)
S ess, emo ional exhaus ion, and dep essi e symp oms
a e all connec ed o sleep dis u bances, a common p oblem
among wo ke s, who o en a ibu e poo sleep o ac o s a
wo k (Lin on e al., 2015). S ess a ousal, wo ying, and
emo ional deple ion may all make sleep di icul . Sleep dis-
u bances include di icul ies alling asleep, es less sleep,
and p ema u e awakening (No din e al., 2013). Poo sleep
has a nega i e, ecip ocal ela ionship wi h men al heal h
p oblems (F eeman e al., 2020). Sleep is one o he majo
means o eco e ing om s esso s (Åke s ed e al., 2016).
In sum, illbeing in e ms o hese men al heal h p ob-
lems may ha e nega i e e ec s, bo h o he indi idual
wo ke in e ms o su e ing, bu also o socie y, since
wo ke s’ sick lea e and income loss amoun s o subs an ial
economic cos s and losses.
A mo e comp ehensi e iew o heal h o
wo ke s engaging in sel -employmen
While heal h o sel -employed wo ke s has been s udied
wi h a ocus on illbeing in e ms o men al heal h p oblems
(S ephan, 2018), a mo e comp ehensi e iew on heal h
also encompasses aspec s o well-being (Wo ld Heal h
O ganiza ion, 1958, 1984), and a ings o o e all heal h,
o en called sel - a ed heal h (SRH; Jylhä, 2009).
Well-being may be de ined as expe iences o pleasu e
and happiness, and a s i ing o op imal psychological
unc ioning and sel - ealiza ion. Wiklund e al. (2019)
highligh he cen al ole o well-being in comp ehending
he heal h o sel -employed indi iduals and show ha sel -
employmen is in ica ely linked o pe sonal g ow h, pe -
o mance, and ul illmen . In addi ion, expe iences o
well-being a e bene icial o heal h and longe i y, o
example, when i comes o he ca dio ascula , immune, and
endoc ine sys ems (Diene e al., 2018). Indi iduals expe i-
encing well-being end o li e a heal hie li e and ha e be -
e social ela ionships, ha e highe wo k pe o mance, and
con ibu e mo e o socie y in gene al (Diene e al., 2018).
Wi h ega d o wo k, well-being is o en s udied h ough
wo k sa is ac ion. Wo k sa is ac ion is jus one aspec o
well-being, bu i plays a c ucial ole in an indi idual’s
o e all well-being and quali y o li e (C anny e al., 1992;
Locke, 1969). A sa is ying wo k expe ience is cha ac e -
ized by posi i e a ec (Wa & Inceoglu, 2012). Gene ally,
wo k sa is ac ion ep esen s a ela i ely s able e alua ion
o one’s wo k, combining bo h cogni i e app aisal and
a ec i e eac ions de i ed om ha app aisal.
In addi ion o eeling sa is ied wi h one’s wo k, eeling
heal hy o sa is ied wi h one’s heal h has also been concep u-
alized as an impo an domain o well-being by Diene e al.
(1999). In o he wo ds, well-being ela es o a pe son’s o e -
all con en men , sa is ac ion, and a posi i e eeling abou li e
in gene al o speci ic domains (Danna & G i in, 1999).
In gene al, he ela ionship be ween well-being and heal h
p oblems, social li e, and wo k pe o mance seem ecip o-
cal. Fo example, well-being helps p e en heal h p oblems,
bu absence o heal h p oblems also gene a es well-being
(Diene e al., 2018). Howe e , an indi idual’s comp ehen-
si e heal h expe ience migh no equal a simple equa ion in
which posi i e and nega i e aspec s o heal h p oblems o
well-being can me ely be added and sub ac ed. While he
p esence o bo h physical and men al illbeing has a nega i e
ela ionship wi h he expe ience o well-being, indi iduals
make o e all subjec i e judgmen s conce ning hei heal h
based on hei own si ua ion and i s de elopmen o e ime.
Thus, one canno assume ha indi iduals expe iencing illbe-
ing necessa ily expe ience impai ed well-being and heal h
(Bujacz e al., 2020; Wikman e al., 2005). Hence, in addi ion
o assessing illbeing and well-being, a mo e comp ehensi e
unde s anding o an indi idual’s heal h expe ience can be
de i ed by also assessing he indi iduals SRH.
In ea lie esea ch, heal h o sel -employed wo ke s has
been ope a ionalised as any hing om pu e mo ali y a es
(Toi anen e al., 2016) o happiness (Bujacz e al., 2017), o
sel a ings o heal h (Be nha d-Oe el e al., 2024). Al hough
hese s udies co e impo an heal h p oblems, aspec s o
well-being, o o e all indi idual judgmen s conce ning
heal h, hey do no ake a comp ehensi e app oach. This
yields a lack o unde s anding o how illbeing, well-being,
and SRH oge he con ibu e o an indi idual’s heal h. Thus,
in ou s udy, we will s udy heal h o sel -employed wo ke s
h ough illbeing in e ms o men al heal h p oblems, well-
being in e ms o wo k sa is ac ion, and mo e o e all heal h
in e ms o SRH o sel -employed wo ke s.
Heal h o sel -employed wo ke s has o en been s udied
in compa ison o employed wo ke s (Be gman e al., 2021;
Gonçal es & Ma ins, 2018). In gene al, hese s udies ind
ha , on a e age, sel -employed wo ke s a e somewha
heal hie and expe ience highe le els o well-being han
hei o ganisa ionally employed coun e pa s. Howe e , i
is also es ablished by esea ch ha sel -employed wo ke s
expe ience highe le els o wo k s ess han employees
(S ephan, 2018). Ye , many o hese compa a i e s udies
ha e used c oss-sec ional designs, so ha he de elopmen
o heal h o e ime, bo h in hose who a e consis en ly sel -
employed, and hose who swi ch be ween sel -employ-
men and o ganiza ional employmen , is poo ly unde s ood.
Fu he mo e, he pa adox o high s ess and high well-
being highligh s he complexi y o heal h as a concep , and
he e is a need o a mo e comp ehensi e, long- e m iew
o heal h in esea ch o sel -employed wo ke s, aking
hei he e ogenei y in o ega d.
Unde s anding he ela ionship be ween heal h
and wo k
Wo k cons i u es a signi ican aspec o indi iduals’ li es
and can ha e p o ound e ec s on hei heal h. Illbeing, pa -
icula ly s ess, o en has oo s in he wo kplace. The ela-
ionship be ween heal h and wo k can be unde s ood h ough
wo k-s ess models such as he Job demands- esou ces
model (JD-R; Bakke e al., 2004) o E o - ewa d
Be gman e al. 681
imbalance model (ERI; Sieg is e al., 1986). The JD-R
model has domina ed s udies o sel -employmen , al hough
i has been no ed ha JD-R may be oo na ow o ully cap-
u e he expe iences o wo k ou side o he adi ional o gan-
iza ional amewo k (Be nha d-Oe el e al., 2019; Bujacz
e al., 2018; S ephan, 2018). Thus, ERI migh be a mo e
ui ul model when ying o unde s and he ela ionship
be ween sel -employed wo k and heal h.
ERI shi s he ocus om esou ces and demands p o-
ided by o ganiza ions o he e o s indi iduals in es in
hei wo k, he ewa ds hey ecei e in e u n, hei enden-
cies o o e commi , and i s impac on heal h (Sieg is ,
1996; Sieg is e al., 1986; Sieg is e al., 2004). ERI pos u-
la es ha employees in es e o in hei wo k wi h he
expec a ion o ecei ing ewa ds in e u n (Sieg is , 1996;
Sieg is e al., 2004). E o e e s o he s ain pe cei ed by
employees due o a ious job demands and esponsibili ies,
such as in e up ions, o e ime, and obliga ions, while
ewa d encompasses he oppo uni ies p o ided by he job,
including sala y, es eem, job secu i y, and ca ee ad ance-
men . In ERI, a hi d componen in e ac s wi h hese wo
ac o s: o e commi men . O e commi men e e s o he
endency o espond o imbalance be ween e o and
ewa d by excessi ely engaging in wo k and desi ing con-
ol. Taking his oge he , he model es s upon he assump-
ions ha an imbalance be ween high e o and low ewa d
inc eases he isk o impai ed heal h and ha o e commi -
ed employees a e a g ea e isk o heal h de e io a ion
(Sieg is , 1996; Sieg is e al., 2004). Wi h hese assump-
ions, he ERI model p edic s wo ke s’ heal h as a unc ion
o wo k ci cums ances and pe sonal disposi ions.
As we ha e a gued, sel -employed wo ke s a e no a
homogeneous g oup, as p e iously assumed in many s udies,
and his he e ogenei y ex ends o hei wo k ci cums ances.
The businesses o sel -employed indi iduals a y g ea ly,
anging om solo en ep eneu s o owne s o companies wi h
hund eds o employees. They may ace challenges o h i e,
and hei wo k hou s can a y signi ican ly. Consequen ly, he
le els o e o and ewa d expe ienced by hese wo ke s a y
g ea ly, and pe sonal cha ac e is ics, such as o e commi -
men , u he in luence how hese ci cums ances ela e o
hei heal h (Sieg is & Li, 2016). In summa y, ERI unde -
sco es he mul i ace ed na u e o sel -employmen and i s
impac on heal h, highligh ing he impo ance o a nuanced
examina ion o en ep eneu ial heal h p o iles.
A pe son-cen e ed app oach o longi udinal
de elopmen s o comp ehensi e heal h
In ecen yea s, he e has been a g owing in e es among
esea che s in examining he long- e m heal h o sel -
employed wo ke s. Howe e , a key limi a ion o hese s udies
is ha hey o en ea wo ke s engaging in sel -employmen
as a homogeneous g oup, assuming hey a e he same (A shi
e al., 2021; Hessels e al., 2020; Sawang e al., 2020), o p e-
de ined subpopula ions based on hei demog aphics (Caliendo
e al., 2023; Li sa dopoulos e al., 2021), o ca ee pa e n
(Koch e al., 2021). This means ha he di e si y in e ms o
heal h has no been s udied in much de ail longi udinally.
One app oach o examining heal h di e si y among
sel -employed wo ke s is h ough pe son-cen e ed me h-
ods, such as la en p o ile (LPA) and la en ansi ion anal-
ysis (LTA). These me hodologies ha e ecen ly gained
a en ion in esea ch wi hin he ields o wo k and o gani-
za ional sciences. They enable he c ea ion o pa simoni-
ous g oupings o esponden s ha a e bo h concep ually
meaning ul and me hodologically aluable. While hese
me hods a e explo a o y in na u e, hey should be guided
by heo y (Spu k e al., 2020).
Based on a couple o no ewo hy s udies ocusing on
well-being o sel -employed wo ke s, we a gue ha a pe -
son-cen e ed app oach may be ui ul o iden i y exis ing
subg oups, each cha ac e ized by hei dis inc heal h p o-
iles in he he e ogeneous popula ion o wo ke s who en e ,
emain in o exi sel -employmen . Gish, Guedes, e al.
(2022) s udied sel -employed and employed wo ke s in
wo di e en samples. They based hei p o iles on well-
being and pe sonali y, inding ou p o iles o a ying well-
being. In ano he s udy, Bujacz e al. (2020), s udied only
sel -employed wo ke s, and iden i ied six dis inc p o iles
based on well-being. These anged om lou ishing o
unhappy. Bo h s udies highligh he he e ogenei y o well-
being in sel -employed wo ke s. These s udies show ha
p o ile analysis is a bene icial app oach o assessing heal h
in sel -employed wo ke s o unde s and di e ences in hei
heal h. Howe e , hey did no assess illbeing, no de elop-
men o well-being o heal h o e ime. Thus, insigh s o
hese aspec s o heal h in sel -employed wo ke s a e s ill
lacking. While i is di icul o sugges he exac numbe
and shape o subg oup p o iles be o ehand, based on ea lie
esea ch, we expec a leas one p o ile wi h good heal h on
all o mos aspec s o heal h, one p o ile wi h mos ly poo
heal h, and one o mo e wi h di e en combina ions o
good and poo heal h. Fu he mo e, we expec ha he p o-
iles will be ela i ely s able o e ime ( he same p o iles
occu ing o e ime and a majo i y o wo ke s s aying in
he same heal h p o ile o e ime) while change may occu
o smalle g oups. Ou i s esea ch ques ion he e o e is:
RQ1. Which heal h p o iles can be dis inguished among
wo ke s who engage in sel -employmen , how p e alen
a e hose p o iles, and how do he wo ke s ansi ion
be ween hese p o iles?
Heal h p o iles o e ime in ela ion o wo k
e o , ewa d, and o e commi men
ERI can p o ide a s uc u ed app oach o unde s and he
complex ela ionship be ween sel -employed wo k and
heal h and can hus be used o alida e p o iles o heal h.
ERI’s unique pe spec i e o ex insic (e o and ewa d)
682 Business Resea ch Qua e ly 28(3)
and in insic (o e commi men ) ac o s may p o ide an
unde s anding o he in e ac ion o wo k and heal h in
ways ha o he wo k-s ess models ha e ye ailed o
explain. O e commi men migh be pa icula ly ele an
when s udying sel -employed wo ke s. They a e a a
highe isk o wo king excessi ely (Balducci e al., 2021)
and o en expe ience di icul ies in de aching om wo k
(Ta is e al., 2008). Thus, ERI may be uniquely i o s udy
wo k s ess in sel -employed wo ke s.
Indeed, many s udies ha e con i med he ela ionship
be ween ERI and men al heal h p oblems in he gene al
wo k o ce (Håkansson e al., 2020; Ha ey e al., 2017;
Hinsch e al., 2019; Leinewebe e al., 2020). Fu he
esea ch also indica es a ela ionship be ween ERI and
wo k/li e sa is ac ion (B aunheim e al., 2023; Ge e al.,
2021; Kinman, 2016). Ea lie esea ch using ERI o unde -
s and wo k s ess o sel -employed wo ke s is sca ce. One
excep ion is he s udy by Wol e and Pa el (2019), who used
ERI o explain he posi i e ela ionship be ween s ess and
au onomy wi h imbalance in e o and ewa d, and espe-
cially o e commi men , leading o excessi e wo k. In his
s udy, we will use e o , ewa d, and o e commi men as
sepa a e ac o s o po ay wo k- ela ed ac o s, since he
sel -employed a e known o be agen ic and p o-ac i e and
in es a lo o e o in o hei business ope a ions. To wha
ex en hey may compensa e ERI h ough o e commi men
is no well-known, bu ele an i we seek o unde s and
heal h de elopmen s ye be e . Howe e , he wo k- ela ed
ac o s should a y wi h heal h acco ding o heo y and hus
alida e he p o iles. Thus, ou second esea ch ques ion is:
RQ2. How is membe ship in heal h p o iles a each ime
poin ela ed o e o , ewa d, and o e commi men ?
Rela ionships o heal h and demog aphic
cha ac e is ics o he wo ke
Many longi udinal s udies include demog aphic cha ac e -
is ics as con ols, and in hese, esul s a e con adic i e.
Fo example, Nguyen and Sawang (2016) ound no mean-
ing ul ela ionship be ween heal h (in e ms o men al
heal h and wo k and li e sa is ac ion), and gende , age, and
educa ional le el, bu Dawson (2017) ound ha highly
educa ed sel -employed wo ke s epo ed lowe le els o
wo k sa is ac ion han hei less-educa ed coun e pa s.
Finally, wi h a me a-analy ic app oach Solomon e al.
(2022) ound ha highe educa ion in sel -employed wo k-
e s leads o ade-o s, esul ing in inc eased job s ess and
dec eased job sa is ac ion.
Wi h ega d o gende , when analyzing he da a o
women and men sepa a ely, Li sa dopoulos e al. (2021),
ound ha women migh ace g ea e challenges when ini-
ially ansi ioning o sel -employmen , bu o e ime, hei
heal h bene i ed om being sel -employed mo e han was
he case o men. S ephan, Li and Qu (2020) u he add o
his by showing ha men expe ience heal h imp o emen s
when becoming sel -employed, bu women do no . These
examples illus a e ha he ela ionship be ween heal h o
sel -employed wo ke s and demog aphic cha ac e is ics is
complex and seems o a y depending on how heal h is
assessed, which demog aphic cha ac e is ics a e ocused
upon, and whe he s udies ake longe ime ames in o
accoun .
The a ying esul s o p e ious s udies highligh he
need o longi udinal s udies o hese ac o s oge he and
o s udy no only he p e alence o ce ain demog aphics
in di e en p o iles o heal h, bu also i , and how, hey
p edic changes be ween hese p o iles. This allows alida-
ion o he p o iles as meaning ul desc ip ions o quali a-
i ely di e en g oups, ha canno jus be educed o
demog aphic di e ences.
RQ3a. A e demog aphic cha ac e is ics ela ed o heal h
p o ile membe ship?
RQ3b. Does demog aphic cha ac e is ics p edic ansi-
ions be ween heal h p o iles?
Heal h, en ance, and exi in o sel -employmen
The e is a g owing body o esea ch ocused on he opic o
en e ing in o and exi ing ou o sel -employmen . Howe e ,
he majo i y o hese s udies a e c oss-sec ional in na u e,
p ima ily examining indi iduals’ in en ions o en e o exi
sel -employmen , wi hou s udying ac ual ansi ions. The
c oss-sec ional esea ch examining heal h, ind o exam-
ple ha good heal h is ela ed o in en ion o en e sel -
employmen (Sweida & She man, 2020), whe eas poo
heal h has been linked o he in en ion o exi sel -employ-
men (Lindblom e al., 2020; Sa deshmukh e al., 2021).
Few longi udinal s udies esea ch he ela ionship o
heal h and en ance and exi . Wi h ega d o en ance, in a
s udy u ilizing a quasi-expe imen al design, B. Nikolae
e al. (2020) ound ha heal h in e ms o posi i e and neg-
a i e a ec , is ela ed o en e ing sel -employmen . Thei
indings indica e ha indi iduals who a e o ganisa ionally
employed and expe ience highe le els o nega i e a ec
a e mo e inclined o ansi ion in o sel -employmen .
Nikolo a (2019) conduc ed a s udy acking wo ke s’
heal h be o e and a e en e ing sel -employmen . The
indings indica e ha men al heal h imp o ed o indi idu-
als a e en e ing sel -employmen , while imp o emen s in
physical heal h we e only obse ed among hose who
en e ed sel -employmen due o oppo uni y (in compa i-
son o hose who became sel -employed ou o necessi y),
e en a e con olling o changes in income, psychosocial
ac o s, pe sonali y, and local unemploymen condi ions.
S ephan, Li and Qu (2020) also s udied men al and physi-
cal heal h, and ound ha hose wi h poo e men al heal h
sel -selec ed in o sel -employmen , and expe ienced a
sho - e m imp o emen in men al heal h. In a simila
Be gman e al. 683
s udy, ocusing on well-being, Geo gellis and Yusu (2016)
ound ha wo k sa is ac ion inc eased immedia ely a e
ansi ioning in o sel -employmen bu declined in subse-
quen yea s, po en ially due o unme expec a ions and he
ading no el y o he new en u e.
In e ms o longi udinal s udies o exi ing sel -employ-
men , Nikolo a e al. (2021) ound ha ansi ioning om
sel -employmen o o ganiza ional employmen was asso-
cia ed wi h modes imp o emen s in heal h. Examining
sel -employmen s abili y, Koch e al. (2021) disco e ed a
posi i e ela ionship be ween s abili y in sel -employmen
and be e heal h. Fu he mo e, Be nha d-Oe el e al.
(2019) in es iga ed emo ional exhaus ion and psychoso-
cial ac o s, e ealing ha indi iduals who ansi ioned
om pe manen o ganiza ional wo k o sel -employmen
expe ienced educed exhaus ion and mo e a o able psy-
chosocial ac o s. Howe e , exi ing sel -employmen and
e u ning o pe manen o ganiza ional wo k showed li le
o no change in hese ac o s. These s udies empa hize he
impo ance o conside ing he speci ic ci cums ances su -
ounding he ansi ion and he need o s udy heal h mo e
comp ehensi ely.
RQ4. Does en ance o exi in o sel -employmen p e-
dic ansi ions be ween heal h p o iles beyond he p e-
ious p o ile membe ship?
Me hod
Pa icipan s
Since 2006, S a is ics Sweden (SCB), on behal o he
S ess Resea ch Ins i u e, collec s da a o he Swedish
Longi udinal Occupa ional Su ey o Heal h (SLOSH), a
na ional ep esen a i e coho s udy (Magnusson Hanson
e al., 2018). SLOSH is a ollow-up o he pa icipan s o
he Swedish Wo k En i onmen Su eys (SWES) and com-
p ises oday all SWES pa icipan s 2003–2019 (n = 51,412).
As SLOSH is based on he SWES, i can be ega ded as
app oxima ely ep esen a i e o he Swedish wo king labo
ma ke . All labo ma ke sec o s and occupa ions a e ep e-
sen ed, and he numbe o men and women is app oxi-
ma ely equal. SLOSH was conduc ed e e y second yea
(since 2022 e e y yea ) by means o a pen-and-pape ques-
ionnai e in wo e sions; one o esponden s who wo k a
leas 30% (which in Sweden gene ally is 12 h pe week)
and one o hose who ha e le he wo king o ce, ei he
pe manen ly o empo a ily.
This s udy is based on o he i h o se en h da a collec-
ion (hence o h called wa es 1, 2, and 3) o SLOSH con-
duc ed in 2014, 2016, and 2018 ( o in o ma ion o a i ion,
see Magnusson Hanson e al., 2018). We selec ed hose
who we e sel -employed a leas du ing one o he h ee
wa es (N = 2,327). This selec ion c i e ia we e based on he
ac ha ou s udy aimed a in es iga ing sel -employmen
en ance and exi and associa ions o heal h p o iles, as well
as p o ile change. As some o he esponden s had no
esponded o all wa es, we selec ed hose who had answe ed
a leas one i em in each o he six heal h cons uc s in wo
o he h ee wa es, one o hem ha ing o be wa e 2 (2,016;
N = 593 pa icipan s). Fo in o ma ion o missing on i em
le el, see supplemen a y ma e ials. This selec ion c i e ia
we e employed o achie e a alid heal h p o ile classi ica-
ion, which he en i e s udy es s upon. The inal sample
size o 593 pa icipan s ha was used in his s udy is well
abo e he equi ed sample size o 500 pa icipan s needed
o he employed analy ic echniques (Nylund-Gibson &
Choi, 2018).
Assessmen ools
We assessed heal h in e ms o men al heal h p oblems,
well-being, and gene al heal h, all esponses gi en on
Like - ype-scales. We assessed men al heal h p oblems in
e ms o s ess, emo ional exhaus ion, dep essi e symp-
oms, and sleep dis u bances. We assessed s ess wi h h ee
i ems, asking how he pa icipan s el du ing he h ee p e-
ceding mon hs (Åke s ed e al., 2015). We used he e ised
6-i em subscale o emo ional exhaus ion and a igue om
he Shi om Melamed Bu nou Ques ionnai e (SMBQ) o
assess emo ional exhaus ion. The scale is deemed su icien
o desc ibing emo ional exhaus ion in he gene al popula-
ion (Shi om, 1989; Shi om & Melamed, 2006). We
assessed dep essi e symp oms wi h he symp om checklis -
co e dep ession (SCL-CD6) including six i ems. SCL-CD6
uses a small numbe o dep ession co e cha ac e is ics nec-
essa y o diagnosis so ha he sco es sum up o a meaning-
ul se e i y assessmen (Magnusson Hanson e al., 2014).
Finally, we assessed sleep dis u bances using a subscale o
sleep dis u bances om Ka olinska Sleep Ques ionnai e
(KSQ). KSQ was de eloped o desc ibe subjec i e sleep and
sleepiness in a gene al popula ion (Åke s ed e al., 2016;
Kecklund & Åke s ed , 1992). SCL-CD6, SMBQ, and KSQ
ha e been es ed and deemed i o assess hese cons uc s in
sel -employed wo ke s (Be gman e al., 2021).
We assessed well-being, in e ms o wo k sa is ac ion,
wi h he i em Roughly, how sa is ied a e you wi h you
wo k?, and SRH gene al heal h wi h he i em How would
you a e you gene al s a e o heal h?
Demog aphic cha ac e is ics included in o ma ion o
gende ( emale = 0, male = 1), li ing condi ions (ma ied/
cohabi ed = 0, li ing alone = 1; no child en unde 18 li ing
a home = 0, child en unde 18 li ing a home = 1), educa-
ion (up o uni e si y = 0, uni e si y = 1), age (55 o
younge = 0, 56 o olde = 1). The cu -o o age was based
on he median age, as when dicho omisa ion is needed, his
should be done as close o he median as possible, o a oid
ype I e o (Chen e al., 2007). We coded en ance and exi
o sel -employmen o each o he wo ansi ions ( om
wa e 1 o 2, and om 2 o 3), so ha wo a iables we e
684 Business Resea ch Qua e ly 28(3)
Figu e 1. Final ou -p o ile solu ion iden i ied in he sel -employed wo ke s. P o ile indica o s a e ac o sco es wi h mean o 0
and a s anda d de ia ion o 1 wi h 95% con idence in e als. Low sco es on s ess and exhaus ion indica e good heal h, and high
sco es bad heal h. Low sco es on all o he cons uc s indica e bad heal h and low sa is ac ion, and high sco es good heal h and high
sa is ac ion. Es ima es om he dispe sional simila i y model.
c ea ed: En e ing sel -employmen (all o he = 0, en e -
ing = 1), and exi ing employmen (all o he = 0, exi ing = 1).
To assess e o , ewa d, and o e commi men we used
he scales de eloped by Sieg is e al. (1986). We e ised
he scale, excluding i ems ha we e no applicable o
sel -employed wo ke s, keeping h ee i ems om each
subscale.
All ables and igu es no ed wi h S can be ound in
Supplemen a y ma e ials. S udy i ems and ac o loadings
a e p esen ed in Tables S3 and S5, esul s om con i ma-
o y ac o analysis (CFA) in Tables S2 and S4, co ela-
ions Table S6, and eliabili y assessmen s in Tables S7
and S8.
Analysis s a egy
We analyzed he da a using LPA and LTA. These a e pe -
son-cen e ed analyses, aiming o iden i y subg oups o pa -
icipan s who sha e a simila p o ile o sco es on he
a iables o in e es s (Mo in e al., 2020). Thus, we we e
able o iden i y g oups wi h dis inc heal h p o iles. Fi s ,
we sa ed ac o sco es om measu emen models o he
heal h indica o s and co a ia es o use in he analyses.
These measu emen models ( es ed wi h CFA) p o ided
alidi y e idence o he scales assessing one, de ined con-
s uc each. Second, o es ablish which p o iles o heal h
a e p esen among sel -employed wo ke s, we an LPAs o
each wa e; hus, ollowing he analysis s a egy desc ibed
by Mo in e al. (2020). Thi d, we es ed p o ile simila i y,
which is equi alen o conduc ing analyses o longi udinal
measu emen in a iance. This s ep also p o ided alidi y
e idence o he p o iles’ longi udinal simila i y. Fou h,
we ollowed wi h LTA, es ing ansi ions be ween p o iles
o e ime. Fi h, u ilizing a s epwise app oach, so ha he
new a iables would no a ec he p o ile membe ship, we
added demog aphic cha ac e is ics, en ance in o and
exi ing ou o sel -employmen as p edic o s o ansi ions
abo e and beyond p e ious p o ile membe ship, and e o ,
ewa d, and o e commi men as co a ia es. Heal h in
co a ia ion wi h e o , ewa d, and o e commi men p o-
ided alidi y e idence o he hypo hesized co a iance in
acco dance wi h he ERI model. We conduc ed all hese
analyses in Mplus 8.6 (Mu hén & Mu hen, 2017). In addi-
ion, we used chi-squa e es s o es whe he ce ain demo-
g aphic cha ac e is ics we e mo e p e alen in any o he
heal h p o iles. We conduc ed hese analyses in R (R Co e
Team, 2019). Mo e de ails abou he p ocess a e p esen ed
in he supplemen a y ma e ials.
Resul s
RQ1. Which heal h p o iles can be
dis inguished among wo ke s who engage in
sel -employmen , how p e alen a e hose
p o iles, and how do he wo ke s ansi ion
be ween hese p o iles?
The analysis o measu emen models e ealed ha he
models i ed well in all h ee wa es (Table S2–S5). Thus,
he six indica o s o heal h we e used o o m p o iles a
each wa e. We chose he ou -p o ile solu ion in all h ee
wa es, because i was suppo ed bo h heo e ically and
empi ically, as he ound p o iles we e alike a each wa e
(Table S9). We named he p o iles (1) Mode a e p o ile
(a e age on all heal h assessmen s), (2) Men ally heal hy
p o ile ( ew p oblems wi h men al heal h, sleep dis u -
bances and s ess, bu below a e age gene al heal h and
wo k sa is ac ion), (3) Relaxed and sa is ied p o ile ( e y
low expe iences o exhaus ion, and high gene al heal h and
wo k sa is ac ion), and (4) Exhaus ed and dissa is ied (high
exhaus ion and low gene al heal h and wo k sa is ac ion;
Figu e 1 and Table 1).
Be gman e al. 685
The longi udinal design o he s udy allowed us o
es ima e he p e alence o p o iles a each wa e (Tables
S10 and S11). The p e alence o all ou p o iles s ayed
simila o e ime. The model ha speci ied ansi ions
be ween wa es 1 and 2, and be ween 2 and 3 as s a iona y
had he bes i (Table S12), indica ing ha changes we e
s able o e ime. This model was used o he ollowing
analyses. The mode a e p o ile was he la ges a all ime
poin s, ollowed by he Relaxed and sa is ied and he
Exhaus ed and dissa is ied p o iles, whe eas he Men ally
heal hy p o ile was smalles . T ansi ions be ween p o-
iles a e ep esen ed by he pe cen age o sel -employed
wo ke s who changed p o ile be ween wa es (Figu e 2,
co esponding o Table S15). Mos pa icipan s s ayed in
he same p o ile o e ime (61.6%–76.3%). Pa icipan s
who changed p o iles mos ly mo ed om he Mode a e
o he Relaxed and sa is ied p o ile (23.2%–28.7%), and
om he Exhaus ed and dissa is ied o he Mode a e p o-
ile (18.7%–26.5%). Few pa icipan s swi ched om he
Relaxed and sa is ied o he Exhaus ed and dissa is ied
p o ile (1.9%–7.6%).
RQ2. How is membe ship in heal h p o iles a
each ime poin ela ed o e o , ewa d, and
o e commi men ?
The analysis o measu emen models e ealed ha he
models o e o , ewa d, and o e commi men i ed well
in all h ee wa es (Tables S4 and S5). The simila i y model
ha es ained ela ionships o be he same o e ime had
be e i han he ee model (Table S17). Pa icipan s o
he Mode a e and Relaxed and sa is ied p o iles we e dis-
inguished by abo e a e age e o and ewa d, bu below
a e age o e commi men . Fo he pa icipan s o he
Mode a e p o ile, hese es ima es we e a ound he o e all
mean, bu o he ones in he Relaxed and sa is ied p o ile,
he pa e n was mo e dis inc . Pa icipan s o he Men ally
heal hy and he Exhaus ed and dissa is ied p o ile expe i-
enced low e o , low ewa d and high o e commi men .
In he Men ally heal hy p o ile, hese expe iences we e
a ound he sample mean; howe e , o he pa icipan s o
he Exhaus ed and dissa is ied p o ile hey mo e dis inc
(Figu e 3, co esponding o Table S18).
RQ3a. A e demog aphic cha ac e is ics ela ed
o heal h p o ile membe ship?
Wi h a couple o excep ions, demog aphic cha ac e is ics
we e simila in all p o iles o e he h ee wa es ( o o e -
all sample cha ac e is ics, see Table S16). The e was a s a-
is ically signi ican di e ence in age be ween membe s o
he Mode a e (m = 55 yea s, 95% con idence in e al
[CI] = 54, 57) and Men ally heal h p o iles (m = 51 yea s,
95% CI = 48, 53) du ing wa e 1. Fu he mo e, s a is ically
signi ican di e ences exis ed be ween he equencies o
educa ional le el du ing wa e 2 (χ2 = 8.3, d = 3, p = .04).
Pos hoc es s indica ed ha hese s a is ical di e ences
exis ed be ween he Mode a e (54% wen o uni e si y)
and Exhaus ed and dissa is ied p o iles (41% wen o uni-
e si y; χ2 = 4.4, d = 1, p = .04), and he Relaxed and sa is-
ied (59% wen o uni e si y) and Exhaus ed and
dissa is ied p o iles (χ2 = 7.1, d = 1, p = > .01). In compa i-
son, 55% o pa icipan s in he o e all sample wen o
uni e si y.
RQ3b. Does demog aphic cha ac e is ics
p edic ansi ions be ween heal h p o iles?
Fo he LTA, bo h he ee and he simila i y model ha
es ained ela ionships o be he same o e ime indica ed
ha some demog aphic cha ac e is ics had a small, bu s a-
is ically signi ican ela ionship wi h p o ile membe ship.
The simila i y model, which indica ed be e i han he ee
model, demons a ed ha sel -employed wo ke s who had
highe educa ion we e sligh ly mo e likely o ans e o he
Exhaus ed and dissa is ied p o ile han he o he s (Mode a e
p o ile: odds a io [OR] = 1.25, 95% CI = 1.03–1.52, p = .02,
Men ally heal hy p o ile: OR = 1.28, 95% CI = 1.08–1.53,
p = .01, Relaxed and sa is ied p o ile: OR = 1.16, 95%
CI = 1.01–1.35, p = .04). Howe e , in he LTA, he null
model had be e i han bo h he ee and he simila i y
model, indica ing ha he demog aphic cha ac e is ics we e
Table 1. Means and s anda d de ia ions om he dispe sional simila i y model o heal h indica o s in each p o ile on hei o iginal
i em esponse scales, which a e p esen ed unde he a iable names. P o iles: 1. Mode a e, 2. Men ally heal hy, 3. Relaxed and
sa is ied, and 4. Exhaus ed and dissa is ied.
S ess Dep essi e
symp oms
Emo ional
exhaus ion
Sleep
dis u bances
Wo k
sa is ac ion
SRH
1–4 1–5 1–7 1–6 1–8 1–5
1 1.70 (0.52) 1.95 (0.90) 2.43 (1.22) 2.86 (1.04) 6.46 (1.24) 4.03 (0.60)
2 1.17 (0.29) 1.23 (0.25) 2.49 (1.27) 1.94 (0.64) 6.22 (2.00) 3.91 (0.82)
3 1.64 (0.60) 1.97 (0.79) 1.84 (0.76) 2.85 (1.02) 6.92 (1.20) 4.59 (0.62)
4 1.96 (0.82) 2.07 (0.88) 3.52 (1.53) 3.07 (1.08) 5.91 (1.52) 3.41 (0.78)
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