Experiences of Employment Precariousness and Psychological Well-being in East Central Sweden

Background: In the past decade, temporary employment arrangements, including fixed-term and sub-contracted jobs, as well as project work, on-call work and work via temporary-help agencies have increased in developed countries, including Sweden. The objective of this study was to explore precariously employed individuals’ experiences and perceptions of employment strain and its effect on their psychological well-being in Gävleborg County, Sweden. Methods: Semi-structured interviews were conducted with 16 respondents residing in Gävleborg County about their experiences of precarious employment and their perceptions of the relationship between their precarious employment and psychological well-being. Thematic analysis was conducted to relate the results to the employment strain framework. Results: The main theme to emerge in the data was managing stress. Respondent’s perceived significant stress related to keeping employment as well as having future work. In addition, they had difficulties in coping with everyday life because of economic strain, lack of work opportunities and isolation. Conclusions: The results of this study highlight how precariously employed individuals are unable to cope with the stress related to uncertainty in maintaining their current work or having control of their working hours. In addition, the results indicate that precariously employed workers experience economic strain related to income uncertainty, which affects their ability to cope with daily life.


Introduction
In the past decade, temporary employment arrangements, including fixed-term and sub-contracted jobs, as well as project work, on-call work and work via temporary-help agencies have increased in developed countries, including Sweden [1][2][3][4][5][6]. According to the most recent statistics temporary employment in the 27 EU countries went from 11.2% in 2001 to 12% in 2012. For Sweden, the corresponding figures were 13.8% and 14.7% [7].
It is suggested that the flexible labour market follows a core-periphery structure. The core of employees with a relatively secure labour market status is usually surrounded by spheres and sectors of a "buffer workforce" with various forms of more unstable and insecure work arrangements that carry higher risks of unemployment and other social disadvantages [8][9][10][11][12][13][14]. The relationship between different types of insecure employment and health outcomes continues to be a subject of much debate, with some researchers suggesting that it can be beneficial to workers from the perspective of allowing them to control their work time, sample a variety of work experiences, prepare for permanent employment, and positively combine work and family life, particularly for women [15][16][17]. poorer working conditions [18][19][20]. Moreover, a number of researchers have suggested that temporary employment can damage health, whether the health outcome being measured is psychological distress, depression, physical health, morbidity or chronic disease, including when the health status is selfrated [21,22]. Furthermore, some researchers have indicated that the negative health effects of temporary employment may be outcome-specific and that the poorer health of temporary workers may depend on their social and environmental context [23][24][25][26][27]. Notwithstanding, there is agreement among researchers that women continue to do worse than men in health terms within precarious employment [24,[26][27][28]. Using data from a Statistics Canada survey of labour and income dynamics, Fuller et al. [27] found that not only were women more than two and a half times more likely than men to be in part-time employment, but also they were more likely to earn less than US$ 10 per hour, and to report poor mental health. Additionally, other studies have found worse health outcomes among ethnic minorities in precarious employment, especially some specific groups of migrants and non-documented migrants [29].

Relationship between employment strain and psychological well-being
In this study, we departed from the Lewchuk et al. conceptual framework regarding employment strain and health [30] to understand how precarious types of employment might damage psychological health. This framework draws on ideas from the Karasek job strain model, which focuses on stresses linked to control and other issues surrounding a work organization and addresses uncertainties, control and support factors surrounding the employment relationship itself [30,31].
The three core measures of the employment strain and health framework are: (1) employment relationship uncertainty (uncertainty over future employment, the terms and conditions of future employment and work schedules); (2) employment relationship effort (effort spent to keep employment, and balance the demands of multiple employers or multiple work locations); and (3) employment relationship support (from labour unions, co-workers, family and friends). The overall assumption is that employment strain increases when employment relationship uncertainty is high and the effort required to find and keep employment is significant. This combination of precarious uncertainties can influence stress levels and ultimately psychological health [30]. The limited available evidence has shown that workers who experience high levels of employment relationship uncertainty and high levels of employment relationship effort have poor health outcomes [30,31], regardless of whether the workers have support or not. For instance, in a Canadian study [31], it was observed that workers who were in unsustainable precarious employment with no support were trapped in an employment cycle characterized by an unstable, poorly paid and toxic employment relationship, and very poor health.
There is a paucity of research in Sweden regarding precarious employment and psychological health-related outcomes, even though the number of people trapped in this type of employment has grown exponentially. Other studies [32,33] have found that less-educated workers in temporary employment had poorer health than their better-educated counterparts in the same type of employment in North Sweden. In addition, Jonsson et al. [34] reported that although little research has addressed the phenomenon of precarious work in Sweden, evidence from sociological research has shown a gendered character to employment that appears to be an outcome of a unique interaction between the Swedish welfare system and the labour market. They highlighted the need for more research in the area to help disentangle the pathways and mechanisms of the relationship between precarious employment and health within the Swedish context [34].
In Gävleborg County in particular, previous populationbased studies (quantitative in nature, have found high levels of anxiety among employed individuals [35]. However, due to the small sample sizes in these studies, it was not possible for the researchers to stratify their analysis into secure and insecure types of employment [35]. Therefore, the objective of the present study was to specifically explore precariously employed individuals' experiences of employment strain and their perceptions of its effect on their psychological wellbeing.

Methodology Study setting and participants
A qualitative methodology was conducted to explore the experiences and views of individuals with precarious employment, since qualitative methods are useful in studying selected issues in depth and detail [36]. In this study, we employed a qualitative design entailing semi-structured interviews of residents of Gävleborg County, which sits on the Baltic Sea coast of Sweden and has a vibrant combination of industry and services. The sample of 16 respondents was purposively selected (a purposively driven sample) and included people aged 18 and over who worked in insecure forms of employment and were registered in different labour unions as well as unregistered workers across the county who were on short-time work contracts or on hourly employment with or without a contract.
The sample consisted of thirteen women aged 20 to 50 years of age and three men 20 to 40 years of age. The majority had secondary or similar education. Furthermore four participants were married, eight cohabitated with a partner and four were single. Only five participants had children.
The recruitment of participants was done with the help of the regional labour unions using the study inclusion criteria described above. To avoid recognition of individual participants, age is presented as age groups and occupation as broad types of occupation. All but one respondent were born in Sweden.

Data collection
In order to gain understanding of the participants' experiences of precarious employment and employment strain and their effects on psychological well-being, we developed a semi-structured interview guide incorporating open-ended questions covering the three domains of the employment strain model [30,31]: (a) employment relationship, earnings and scheduling uncertainties; (2) employment efforts; and (3) support from labour unions, co-workers, family and friends. In addition, an array of socio-demographic variables was collected. The interviews, which took place spring 2015, ranged from 20 to 55 minutes in length, lasted 35 minutes on average and took place in a location of the participant's choosing. Six interviews were carried out at the University of Gävle's Department of Occupational and Public Health Sciences, six interviews in the respondent's own home and four interviews in a study room in a public library. All the interviews were carried out in undisturbed rooms. Prior to the interviews, the respondents were asked to give their informed consent (after assurances of confidentiality and information on the objectives of the study). The 16 semi-structured interviews were digitally recorded and transcribed verbatim with the interviewees` permission.

Analysis
The recorded data were transcribed verbatim and coded, and then analysed and interpreted using thematic analysis [36,37]. At its core, thematic analysis is a method for identifying and describing patterns in qualitative data. Its flexibility allows for the construction of an analysis that best suits the data and the scope of the research questions.
A two-stage approach was adopted for the analysis, as suggested by MacFarlane and O'Reilly-de Brún [38]. Initially, an inductive thematic analysis was performed using the six steps described by Braun and Clarke [37] and thereafter the emergent themes were mapped into the three domains of the Lewchuk et al. employment strain model [30,31].
The inductive stages of the analysis were initiated by reading the transcripts several times, to become familiar with the data. Initial codes were then generated for each interview separately, and thereafter the codes were put together with the aim of forming potential themes. The constructed themes were then reviewed and checked for suitability in relation to the codes and the data. The final inductive stage included the definition and labeling of the themes.
When the inductive thematic analysis was complete, a strong resonance was found between the emergent themes and the three domains of the Lewchuk employment strain model. This was an iterative process, moving backwards and forward between the emergent themes and the literature on the employment strain model. The theme and sub-themes were defined by inter-subjective agreement between the authors, to enhance the trustworthiness of the study data [36].

Ethical approval
The study protocol and interview guide were approved by the Regional Ethical Committee in Uppsala. Furthermore, participants were informed of the purposes of the study, and their informed consent was sought before each interview was carried out and digitally recorded.

Results
In the study data, we identified the overarching theme of managing stress and three sub-themes. The sub-themes were: (1) employment uncertainty -struggling to make ends meet; (2) employment effort -constant search for work opportunities and (3) support from employers, family and friends. The overarching theme and the sub-themes in the study findings are discussed in turn in this section, with quotations from the interview transcripts used to support the findings.

Managing stress
The overarching theme of managing stress described how individuals with precarious employment have to manage the stress they experience in their everyday life. The stress resulted from their constant efforts to stay employed or gain new work opportunities, at the same time as looking after their finances, family and housing, both in the present and in the future. To be able to handle the stress, these individuals sought to find strength within themselves, with support from others. One participant commented on the difficulties in meeting this stress: Stressed well, this particular stress -that you do not know, you do not even know how tomorrow will look. It's difficult to plan ahead. And also different working hours, at different workplaces, with different colleagues and different tasks makes it a fairly volatile life. You rush from one place to another, and so there is a stress. And it is precisely this, that one never really has a life outside work. The phone rings and it is always difficult to say no. This is a stressful situation. Respondent 15.

Employment uncertainty-struggling to make ends meet
Respondents talked about their constant struggle to make ends meet, difficulties in managing everyday life and concerns about the future. In addition interviewees expressed concerns about their economic situation. As their income in many cases varied from one month to another, they experienced difficulties in planning their expenses and how to cover them. Not having enough money was described as stressful, especially when having a family to care for. While in precarious employment, they found it also difficult to obtain a pay increase or a loan. Although some of the respondents received financial support from their spouse or other relatives, this was not perceived to be a solution. One of the respondents stated: Among the respondents, it was common not to know in advance when they would be working or how long the shift would be. Respondents working in health care explained how they sometimes were told about a shift the same morning, while respondents working in the services field described not knowing whether they would be working for four hours or for 19 hours, as the work time depended on the customers' needs. As a result, they experienced difficulties in managing their everyday life. For example, respondents described difficulties in planning social activities, taking care of their children and knowing when to go to bed. As one participant commented: I can say now, what stresses me a lot is that you do not know if you'll work tomorrow, or if you're working tonight. You cannot plan with your family, with your children, or for your own time. I don't have time to go the hairdresser or for a massage or for exercise. I cannot plan anything. The employers control me how they want. Respondent 11. Summer holidays were also described as problematic. Since there are more employment vacancies during summer, it was common not to take any summer holiday with the family at all, which was not appreciated by other family members.
Concerns about the future produced feelings of insecurity and inner stress. The respondents described negative feelings of being unable to influence their own future. For some of the respondents, their thoughts and concerns led to sleeping difficulties, eating problems and feelings of meaninglessness. Others did not dare to move from their parents' home or plan for any bigger life event, such as purchasing a house, having children, or planning a holiday or trip. Regarding having children, one participant said: I can only imagine what it would be like to have children. It would never work. Therefore, I said to my partner that we should wait to have children until I have a permanent job and everything is safe; otherwise, it will not work. It does not work, I think, to have children when employed on an hourly basis. Respondent 13.

Employment effort -constant search for work opportunities
According to the respondents, staff with precarious employment seldom had the same status as full-time employees. When working on a short contract or being employed by the hour, they found it difficult to influence their work situation. Examples were given about not receiving the correct information, not being listened to and being given lower priority by the labour unions. Feelings of being exploited were also not uncommon. Having precarious employment could, according to respondents, be facilitated by an employer showing understanding and offering them the possibility of participating in decision-making at work. One participant stated the following: That you are allowed to join in, and think and have your opinions. I think that's really important. Because if you have a customer whom you work with now and then, you want to be with and hear what is being said about that person, and if there are some changes and things like that. Within the municipality, it becomes more that you can read it in different folders and things like that when you come back. Respondent 5.
Some participants stated that precarious employment forced them to always show their best side, as well as perform better than their colleagues who were employed full-time. They reported the need to always demonstrate that they would never turn down a work offer or require work of their choosing. One respondent expressed it as having their own trademark and being known for carrying out good work. Other ways to become indispensable were to always show a happy face and to seek their colleagues' approval by being, for example, the one who always makes coffee for everyone. One respondent said: Yes exactly, it's tough, it's constant, that we both must do a good job and have to show that you are a good person and have to be friends with everyone. You must be happy because you have had an opportunity to work. Yes, you get into the workplace simply in a good way, and work that much, try to take the initiative and be, well, energetic. Respondent 16.
Respondents indicated that they lacked the security of fulltime work because of their constant need to search for work opportunities. Different ways to do this searching included asking the employer for more shifts, looking for other positions and extending their network of contacts. One participant described this search in the following way: Yes, I've got many balls in the air. I can see that I have to have not only a plan A or plan B, but also a plan C. That does not work here, [I say to myself,] so how can I do it well as I jump in and work only when needed? Or can I jump in and be in a different place? I have to have openness; OK, it does not work in one place, so I have to solve it in another way. Respondent 10.
Participants employed by the hour described the stress resulting from needing to constantly be ready to work. Many respondents described a system in which they receive work enquiries as text messages on their phone. The same individuals indicated that the person who replied the most rapidly would have the opportunity to work that shift. Therefore, they needed to always watch their phone, since they were afraid of missing an enquiry or answering too late. For example, one respondent expressed: I receive a text message asking if I want to work or not. I have to answer yes or no. It may have gone out to ten other people, so one has to be the quickest to answer yes. It is a giant stress. The worst is when you're working, anticipating that a text message will come anyway even though I'm at work. And then maybe I do not hear [the phone]. And then I will lose it [the opportunity to work], because I did not hear and cannot answer. Then I've not received the work session, because then surely someone else got it before me. You only have seconds to answer. We are so many stand-ins who want to work. So it's about seconds. Respondent 3.
Regardless of having such a system or not, respondents described a situation of always searching for work opportunities and never daring to turn down a work opportunity, since doing so could jeopardise their future opportunities.

Support from employers, family and friends
Many respondents did not feel supported by their employers as they felt insecure as compared to their permanently employed counterparts. They perceived that they needed to always prove themselves in order to keep their insecure employment. However, a number of respondents described support from the employment office and from the labor unions as important, while others had not received any support at all or were deeply dissatisfied with the support they had received. For some respondents, the possibility of compensation from the unemployment benefit fund was a source of security.
In the study, interviewees living on their own had to care for their own financial situation, while some respondents living with a spouse or with their parents could count with financial support from their family members. This support was appreciated, although being dependent on family members was viewed as a temporary emergency solution. Having to live with their parents as an adult because of financial problems or having to ask their spouse for money was described as an undesirable situation. As one participant stated: This particular dependency situation, it makes a person shrink. For you to have your own self-esteem, I think it is important that you actually have a permanent job, you can support yourself, you can plan and you can buy stuff by yourself. You should not have to go and ask your husband for help. Respondent 9.

Discussion
Our study found that respondents: (a) perceived significant stress related to maintaining employment as well as having future work; (b) had difficulties coping with everyday life owing to economic strain, a lack of work opportunities and isolation; and (c) experienced little or no workplace support, specifically perceiving that they lacked a place within the organization they worked for.
Previous research, predominantly in the form of quantitative studies, has found a high prevalence of selfreported stress among precariously employed individuals. For instance, in a mixed-methods study carried out in Canada, Lewchuck et al. [31] reported a gradient of strain resulting from the interaction between the amount of effort individuals expended to find and maintain employment, as well as from the degree of uncertainty related to having future work and its terms and conditions. In our study, respondents experienced continuous stress owing to the uncertainty of maintaining their current work, in terms of what tomorrow's work opportunity will look like and how many hours they will work, and also owing to their constant desire to find a permanent job; this uncertainty and desire for work in turn decreased their sense of well-being. As an example, one respondent described the stress associated with waiting for a text message that would indicate a work opportunity for that specific day. This stress and uncertainty largely result from the message sender requiring a response in just a matter of seconds, with the first person who accepts the opportunity (among the pole of different message recipients) being given the work on that day.
Respondents in our study also spoke of difficulties in coping with everyday life, especially because of their economic situation. This finding has been reported in the few available qualitative studies. In Canada and Spain, respondents who were forced into precarious types of employment felt trapped in work arrangements that resulted in unstable earnings and deprived them of sufficient resources to pay their bills and take care of their basic needs [28,30,31]. In our study, respondents considered that they had no control over their work or economic situation. This was reported in particular by the workers on-call, who overwhelmingly said they had no control of their work schedule, with little or no appropriate advance notice of what their schedule would be.
Also, interviewees in this study reported that they were unable to spend as much time with their family as they would have liked because of the economic strain resulting from the uncertainty in both their earnings and their work schedules. In Canada, Lewchuck et al. [31] found that most individuals in the unsustainable and precarious employment group experienced limited degrees of family, household and individual support. In addition, their study reported that most precariously employed respondents came from households where other family members were also in precarious work and had dependents (e.g. children or elderly parents). Furthermore in that study, workers who were in the most precarious employment situations felt unable to cope with the constant worry about money for a range of expenses such as housing, transportation and childcare. Regarding sustaining friendships and romantic relationships, precarious workers spoke of being too tired and too depressed to do anything social, and stated that long working hours had impaired their health and wellbeing. Our study did not permit us to ask about other social circumstances such as housing, transportation and childcare, and only five respondents reported having children in their households. Although we did not ask questions regarding other social circumstances in our study, it is reasonable to speculate that the social context of Sweden, which is characterized by a strong social welfare state and unemployment benefits system, would be able to buffer the overall consequences experienced by precariously employed workers.
Regarding support, respondents in our study expressed feelings of being isolated and lacking support from the workplace. Other qualitative studies have found similar results. In Canada, Lewchuck et al. [31] reported that most precarious employees felt isolated and were vulnerable to poor treatment at work, harassment, and gender and race discrimination. Furthermore, Bosmans et al. [39] reported that temporary workers expressed feelings of unfairness and injustice when compared with their permanently employed counterparts. In our study, respondents complained of a lack of support from employers. Other studies have highlighted the role of workplace social support in reducing stress and improving health [40].
Our study did not ask respondents regarding employment preference (if they chose voluntarily to be temporary workers) or which type of contract they had. However, almost all of the participants reported themselves as involuntary employees. In a study that investigated job insecurity and health-related outcomes among different types of temporary workers Silla et al. [9] found that traditional temporary workers had lower life satisfaction than transitional, permanent temporaries and permanents. They argued that traditional temporaries perceived themselves as having less control over their environment. However, other research shows that voluntary temporary workers (that chose to take only temporary work) had high levels of overall intrinsic and extrinsic satisfaction as well as the lowest levels of stress (regarding role ambiguity and role conflict) [41]. In another study Ramos et al found no differences in well-being related health outcomes among temporary and permanent workers [42].

Strengths and Limitations
Overall, the objective of our study was to explore the perceptions of work precariousness and its effects on psychological well-being using the employment strain theorethical framework which has largely been applied to derive quantitative data [31]. To a large extent, the results of the inductive analysis fit well into the three main domains of the employment strain model. Furthermore, the two-stage analytical approach allowed not only for inductive analysis, but also for a process that permitted comparisons with findings in the research literature, which added understanding and conceptual meaning. Also, inter-subjective agreement in the process of analysis and illustrative quotations support the trustworthiness of the study data [36]. However, the group of participants was small and included only one county, which could be considered a weakness. Participants varied widely in age, family situation and type of occupation, and therefore represented a range of experiences. Our study sample as well as its composition is not representative of Sweden or Gävleborg County in particular and not of the entire population of temporary workers in the context of the study. Nonetheless our study provides an exploratory study of perceptions among this population group.

Conclusion
Our results illustrate how precariously employed persons living in Gävleborg County are unable to cope with the stress resulting from uncertainty in maintaining their current work or having control of their working hours. In addition, the results show that these workers also experience economic strain as a result of income uncertainty, which also affected their ability to cope with daily life. Furthermore, respondents expressed feelings of isolation related to a lack of workplace support. Although the study sample size was small, the findings indicate that on-call workers might be exposed to greater strain than other precariously employed workers. Future research is warranted, especially on what coping resources or processes might be of importance for different types of precarious work. From a policy perspective, the findings in this study warrant attention from policy makers and labour unions, because despite Sweden's universal welfare system and generous benefits, precariously employed workers still experience different types of strain, leading to different levels of stress and ultimately decreasing their well-being. In addition, the findings from this study can be of importance for similar geographic settings.