The moderating role of gig work in health-related quality of life varies with workers' dependence on gig work, and reducing the mental health burden of chronic illness may require access not only to employment, but also to high-quality jobs.
Key Findings
Results
Chronic illness is associated with significantly higher psychological distress scores compared to those without chronic conditions.
Individuals with chronic illness reported 1.44 points higher psychological distress than those without such conditions (p < 0.001)
Psychological distress was measured using the GHQ-12 scale with a range of 0–12
Analysis used random-effects models on longitudinal data spanning 2019–2024
Sample consisted of 22,712 British workers from a nationally representative dataset
Results
Both regular employment and low-dependence gig work are associated with lower psychological distress compared to unemployment among individuals with chronic illness.
Regular employment was associated with 0.64 points lower psychological distress relative to unemployment (p < 0.001)
Low-dependence gig work was associated with 0.56 points lower psychological distress relative to unemployment (p < 0.001)
These findings suggest that any employment, including low-dependence gig work, may offer some mental health protection over unemployment
The protective effects of regular and low-dependence gig employment were similar in magnitude
Results
Among men with chronic illness, high-dependence gig work is associated with substantially greater psychological distress compared to regular employment.
High-dependence gig work was associated with a 1.60-point increase in psychological distress relative to regular employment among men with chronic illness (p = 0.004)
No such pattern was observed among women with chronic illness
This finding indicates a sex-specific moderating effect of gig work dependence on the chronic illness–distress association
The result highlights that job quality, not just employment status, matters for mental health outcomes in this group
Results
Women with chronic illness experience greater psychological distress overall compared to men with chronic illness.
The paper reports that 'women with chronic illness experience greater psychological distress overall'
Despite higher overall distress, women did not show the same pattern of elevated distress associated with high-dependence gig work seen in men
This suggests that the gendered experience of chronic illness and gig work dependence operates through different pathways for men and women
The analysis examined sex as a moderator of the gig work–chronic illness–distress relationship
Results
The moderating role of gig work on the chronic illness–psychological distress association varies according to workers' level of dependence on gig work.
Low-dependence gig work showed a protective pattern similar to regular employment relative to unemployment
High-dependence gig work was associated with worse mental health outcomes, particularly among men with chronic illness
The study distinguished between different levels of gig work dependence, finding divergent effects on psychological distress
Longitudinal data from 2019 to 2024 were used to capture these associations over time using random-effects models
What This Means
This research suggests that having a chronic illness significantly worsens mental health, but the type of work a person does can either buffer or amplify that effect. Using data from over 22,000 British workers followed over five years (2019–2024), the researchers found that people with chronic illnesses had notably higher psychological distress scores. However, having a job—whether a traditional employment arrangement or occasional gig work—was generally associated with lower distress compared to being unemployed.
The picture becomes more complex when looking at people who rely heavily on gig work (such as app-based or freelance jobs) as their primary income source. Among men with chronic illness, heavy dependence on gig work was associated with a meaningful increase in psychological distress compared to those in regular employment. Women with chronic illness tended to report higher distress overall, but did not show this same pattern of worsening distress linked to high gig work dependence. This suggests that the mental health risks of precarious or high-dependence gig work may fall differently on men and women living with chronic illness.
This research suggests that simply having a job is not enough to protect the mental health of people living with chronic illness—the quality and stability of that job also matters. Policies aimed at improving mental health outcomes for workers with chronic conditions may need to consider not just employment access but also the nature of work arrangements, particularly as gig and precarious employment continues to grow.
Zai-ping Wang, L. Li, Senhu Wang. (2026). Gig work dependence and psychological distress in chronic illness. SSM - population health. https://doi.org/10.1016/j.ssmph.2026.101927