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Current IssueSpecial IssueEditorial BoardOnline First ArticlesArchive

ABSTRACT

The rise in popularity of apps for food delivery services has led to a gig economy with many people in temporary jobs working under an algorithm; these jobs have unstable pay and lack job security. There have been numerous studies on mental health of gig workers; however, studies remain fragmented in size and scope. In order to fill the gap of knowledge about the mental health of gig workers, the researchers will combine two different methods of analysis (A systematic literature review and a textual thematic analysis) to create a comprehensive understanding of the mental health of gig workers, primarily in Asia. The researchers conducted a structured search of the Web of Science and Scopus databases for peer-review articles between 2020 and 2026 and located 111 studies that met inclusion criteria after the data was screened. A bibliometric analysis and a thematic analysis were employed to identify seven themes: algorithmic control, income stability/instability, job stress and burnout, psychological well-being, safety risks, customer-related stress and work-life issues. The findings of this study indicate that mental illness is primarily caused by structural working conditions, as opposed to personal factors. The authors conclude that there is a need for transparency in algorithms used to determine pay rates, competitive wages for gig workers, social protections for gig workers and overall improvements to occupational health for gig workers; the authors have also created a framework for possible future research and policy development on this topic.

INTRODUCTION

In the last ten years, digital food delivery firms grew quickly and created a large and constantly expanding number of gig workers who are critical to the functioning of urban food systems today. Gig workers deliver food for companies like Zomato, Swiggy, Meituan and Uber Eats and their work is organized via algorithms that track performance, deliver tasks and determine payments. This gig work model allows flexibility, but it also comes with many significant challenges. For example, gig workers often face unstable pay due to constant time constraints, low job security and no benefits. Ultimately, these challenges can lead to significant financial tension, social isolation and safety concerns for many gig workers, which negatively impacts their mental health and overall well-being (De Stefano, 2016; Li, 2026). Following the COVID-19 pandemic, these challenges are even more pronounced. During the pandemic, demand for food delivery services surged, which made gig workers essential to day-to-day life (Kose et al., 2022). Despite having an insecure job and poor health-safety measures being in place for most gig-workers, they were required to complete their work during this time frame (Apouey et al., 2020). As a result of all of this, research related to gig worker mental health has increased across various fields including: occupational health; management and; labour studies. However, there is no clear or comprehensive synthesis of the available evidence due to the wide range and limited coordination of research efforts on gig worker mental health. To fill the knowledge gap between research and the challenges that gig economy workers experience through mental illness in their workplace. Three specific objectives will be accomplished through the combined method of a systematic literature review with textual thematic analysis (TTA). The systematic literature review identifies the structure and trends of current literature including publication rates, geographic locations and methodologies, while TTA identifies key themes and patterns related to the findings. Three general objectives guide this research through six research questions (Bajaj and Sharma, 2024). The first three research questions (RQ1-RQ3) identify the trends, contributors and keywords in the literature, whereas the last three research questions (RQ4-RQ6) will examine worker well-being through reviewing mental health outcomes, identify factors that influence those outcomes and potential interventions that may support worker well-being. The focus of this study is to support the united nations sustainable development goals (SDGs). this study supports SDG 3: Good health and well-being, SDG 8: Decent work and economic growth and SDG 10: Reduced Inequalities, by demonstrating how workers in the gig economy face challenges with respect to mental health and solutions for creating safe, equitable and sustainable and decent working conditions for gig economy and food delivery workers (Rasoli et al., 2021).
 
Theoretical background
 
Using a variety of common theories to understand food delivery gig workers’ experience, the theories collectively illustrate the complexity and stress of working in such an environment. The JD-R Model indicates that stress develops when job demands are high and lack adequate support and resources (Bakker et al., 2017). In gig work, food delivery gigs have a high volume of demand; workers are continually required to meet deadlines and are subjected to app-based monitoring by customers. In addition to high demand this type of work has reliability issues; work is purely dependent on a worker being able to access the app and produce enough income for cost-of-living expenses. Self-Determination Theory provides an additional explanation; for people to be fully motivated and feel satisfied with their work, they need three component parts of their job; autonomy, competence and social relationship. Although many of the advertisements for gig work suggest there is great flexibility, in reality, there is a high reliance on ratings, penalties and isolation to create a false sense of freedom diminishing the ability to experience true freedom due to what is known as the “autonomy paradox” as theorized by Deci et al., (1985).
       
Labour Process Theory adds insight into the issue of how platform companies reduce costs by transferring risks from themselves to workers through contract-type employment and/or algorithmic types of control (Braverman, 1974). “Conservation of resources theory” demonstrates that losing valuable resources can cause an increase in stress (Hobfoll, 1989) i.e., wage stability, social support. Finally, “Transactional model of stress” illustrates that how an individual perceives and copes with the stressors can determine their overall response (Lazarus and Folkman, 1984).
       
This research uses a specific kind of research: Multiple studies (MS)-and combines two different methodologies: Systematic literature review (SLR) and Textual thematic analysis (TTA) (Braun and Clarke, 2019). Systematic literature reviews provide transparency, reproducibility and complete coverage of all evidence; whereas textual thematic analyses are active analytical interpretation and creative construction of concepts based on data. The combination of both SLRs and TTAs in this review allows for both understanding the total number, distribution and quality of evidence available as well as creating theme based on the data that is more than simply descriptive.
 
Systematic literature review
 
Database selection and search strategy
 
To find relevant literature and studies regarding gig and platform workers, a structured Boolean search strategy using the appropriate terminology in conjunction with the multi-disciplinary databases Web of science (WoS) core collection and scopus was completed as both of these databases are comprehensive in providing coverage from all major research areas including management, psychology, occupational health and social sciences (Bounoua et al., 2025).
       
The search strategy was based on three groups of key concepts that were connected using the boolean operator “AND”. The first group of key concepts included gig and platform workers (e.g., gig worker, delivery riders, app-based workers, couriers) and the second group included the context of food delivery (e.g., online food delivery, meal delivery, last mile delivery). The third group included mental health outcomes as they relate to gig workers (e.g., stress, burnout, anxiety, job satisfaction, well-being) within the above-defined parameters.
       
The Boolean search was conducted on titles, abstracts and author-supplied keywords using wildcard characters (*) for the various term variations. There were no restrictions placed at this stage on either document type or subject area to ensure exhaustive coverage of gig and platform workers in the food delivery sector. From WoS there were 44 records and from Scopus there were 67 records for a total of 111 records.
 
Eligibility criteria
 
Following PRISMA guidelines (Page et al., 2021), predefined inclusion and exclusion criteria were applied during title, abstract and full-text article assessed summarised in Table 1. Studies were included if they focused on food delivery or platform gig workers, reported at least one mental health or well-being outcome, were published in English and fell within the 2020-2026 period. Studies focusing solely on logistics, customer experience, or physical health without psychological aspects were excluded, along with editorials, dissertations and non-peer-reviewed works (Mehta et al., 2025). A total of 111 records were identified from web of science (44) and Scopus (67). After merging datasets, duplicate removal was conducted based on DOI normalization, eliminating 25 records, followed by an additional 10 unmatched records removed using title checks. This resulted in 76 eligible studies for final analysis, as outlined in the PRISMA 2020 Flowchart (Fig 1).

Table 1: Inclusion and exclusion criteria for study selection (PRISMA 2020).



Fig 1: PRISMA 2020 flow diagram illustrating record identification, deduplication, screening, eligibility assessment and inclusion stages.


 
Textual thematic analysis
 
In this research, the analysis themes were done using Braun and Clarke’s six-step method (2006, 2019) to analyse. The first step was for the researchers to read through the data several times, becoming familiar with them, looking at the abstracts of all 76 studies and their findings and conclusions to achieve this. The next step was to identify and systematically code the significant patterns within the text. Each theme name was then defined meaningfully and distinctly through ongoing writing and reflection. After defining the name of each theme, they were organised and presented within the overall narrative of the systematic reviews. In this work, we take a critical realist view that recognises a researcher’s view will shape the resulting themes, but that the themes are also created from the real-world experiences of gig workers (Rathod et al., 2025).
       
The point of saturation occurred after approximately 58 studies were analysed as similar themes were found within the data set post the point of saturation. The final structure consisted of seven validated themes which were validated against the total data set before being presented.
 
Publication trends
 
An examination of 76 published works from 2020-2026 indicates a rapid increase in research on mental health for the new category of “food delivery gig worker” and provides evidence of increasing academic and policy interest in this area. From 2020-2025, the number of studies published in the field rose from 5 to 27 and in particular, both 2022 and 2023 saw a significant increase in the number of studies published (6 and 10 respectively). The majority of studies published in 2020/2021 focused on logistics and consumer behaviour opens doors for more studies focused on the mental health of these workers. Between 2023 and 2024, there was the most dramatic increase in publication output, with an increase of 18 studies due to an increased interest from the public, media and policymakers with a focus on Asia. The greatest number of studies published during any given year was 2025 when 27 studies were published. After the end of March, 2026, there will already have been 8 studies published indicating this area will continue to have significant growth in research output illustrated in Fig 2.

Fig 2: Annual (bars) and cumulative (line) publication output for studies on food delivery gig worker mental health and well-being, 2020-2026 (N = 76).


 
Geographic distribution and disciplinary reach
 
The vast majority of gig worker mental health research is done in Asia, comprising over 57% (Yoo et al., 2024). The highest rate of research is being conducted in China, followed by South Korea, Vietnam, India, Malaysia and Hong Kong presented in Fig 3. This trend illustrates the fast-growing number of food delivery platforms in Asia and the need to study workers’ conditions in regions with little social safety net protection. There are great alternative regional research approaches. For example, the majority of Chinese research on gig workers is quantitative, focused on algorithmic control and emphasizes issues such as burnout, stigma and turnover based on platform data. On the other hand, Vietnamese research is focused largely on the area of occupational health and road safety due to high levels of motorcycle use in Vietnam. Finally, research from India focuses on gig workers’ experiences on platforms such as Zomato and Swiggy, focusing on the nature of management practices and worker welfare. Alternatively, a small amount of research conducted in Brazil and Europe provides alternative frameworks regarding the fields of public health and food security.

Fig 3: Geographic distribution of included studies by primary country of data collection (N = 76).


 
Methodological distribution
 
A large number of studies (58%) have used quantitative methods, which tend to be cross-sectional in nature (i.e., they only look at a single point in time). While there is a large number of studies that have used qualitative methods (33% of the studies in this literature), these studies provide more in-depth contextual information about the data. Mixed-methods studies make up a very small percentage of the studies published in this field (7%), despite their potential contribution to a more thorough understanding of the topic.
 
Leading journals and authors
 
There were 76 studies located throughout more than 60 journals which indicated that research for this area is interdisciplinary. A limited number of journals accounted for two studies each and they include: Safety science (Safety science), safety and health at work, frontiers in psychology (Frontiers psychology), BMC psychology (BMC psychology) Employee relations (Employee relations), service industries journal (Service industries) and international journal of hospitality management (IHOM) and research in transportation business and management (RTB) which span a range of different disciplines including health, psychology, management, transportation and Hospitality. Hence the research for gig worker mental health has not yet defined a dedicated outlet in which it can be published as a distinct line of work has not developed. With respect to authorship, the most prolific contributor is Nguyen-Phuoc (Vietnam) with 4 studies focused on burnout, job demands and road safety. Other significant contributors include; Zhang (China), Daufenback (Brazil), Kesane and Spurina (Latvia) whose studies investigate algorithmic control, working conditions, autonomy and inequality. The most influential study to date is Apouey et al., (2020), which has been cited most frequently, is the most notable study to establish a clear link between financial instability (i.e., due to COVID-19) and mental well-being and Nguyen-Phuoc et al., (2023) which measured the association between occupational stress and unsafe driving behaviour. Table 2 provides a summary of the main characteristics of these studies.

Table 2: Characteristics of key included studies selected to represent the corpus (n = 9; full extraction in supplementary material S1).


 
Keyword Co-occurrence and thematic clusters
 
The analysis of author-provided keywords, limited to studies that actually reported them, revealed five clear thematic clusters across the dataset. The most commonly used terms included “gig economy” (8 occurrences), followed by “food delivery” (4) and “well-being,” “job satisfaction,” “platform work,” “algorithmic management,” and “gig work” (3 each). Other recurring terms such as “job stress,” “emotional exhaustion,” “algorithmic control,” “food delivery rider,” and “safety” appeared less frequently (2 each).
       
A noticeable pattern emerges from how these keywords appear together. Terms related to algorithmic management and control are often closely linked with those describing stress, burnout and emotional exhaustion. This pattern supports the broader findings of the review, suggesting that platform-based algorithmic systems act as a key source of pressure, which in turn leads to negative psychological outcomes for gig workers.
 
Thematic analysis
 
Based on the thematic analysis of the 76 selected studies, seven main themes were developed. The themes are summarised Table 3 and further elaborated in the next sections. The themes were created from an interpretive approach which provided insight into the deeper emerging patterns that cross over different methodologies, disciplines and country contexts, in order to develop the themes. All of the themes were connected, rather than being individual. Many studies contributed to more than one theme, which is indicative of how complex and overlapping gig workers’ experiences are. An example of how studies relate to the various themes is illustrated in Table 3 and an overview of how all the seven themes relate is shown in Fig 4.

Table 3: Thematic synthesis: Seven overarching themes constructed from textual thematic analysis (N = 76 studies).


 

Fig 4: Integrative conceptual framework synthesising antecedents, mediating mechanisms, moderating resources and mental health outcomes for food delivery platform gig workers (N = 76 studies).



Theme 1: Algorithmic control and the autonomy paradox
 
The study of 21 studies suggests a major contradiction about platform work: although it is supposed to provide flexibility, there are various control mechanisms (e.g., real-time management via algorithms and rating systems) that produce high levels of burnout and dissatisfaction amongst workers; therefore, they identify a lack of perceived equity and transparency, which, in turn, reinforces these negative feelings. In addition to some workers receiving support in the form of coping strategies, groups and collective support/building a shared understanding amongst other workers are seen to be helpful in combating the effects of high levels of control. Furthermore, high levels of control can also lead to deviance and lower overall platform effectiveness, as algorithms are often seen to reduce both worker well-being and organisation outcomes.
 
Theme 2: Income precarity, structural vulnerability and financial stress
 
There are 20 studies (26.3%) that identify income insecurity as a major contributor to poor mental health. Gig workers often have unstable earnings, do not receive benefits and have little to no access to social protective services. Financial uncertainty appears to be linked with decreased well-being (Apouey et al., 2020); on the other hand, the absence of social insurance has been shown to significantly increase the risk of developing major depressive disorder (depression) (Long et al., 2025). In addition, there are more prominent structural inequalities related to the platform economy as evidenced by cases where workers exhibit food insecurity but are employed in the business of delivering food the algorithms used by platforms tend to prioritize efficiency over worker welfare, placing workers and platforms at greater systemic risk than they already are (Li, 2026). Therefore, these studies suggest that financial instability is not only an individual level problem but also at the systemic or structural level.
 
Theme 3: Job stress, burnout and emotional exhaustion
 
A total of 24 studies (31.6% of total studies) found that burnout was one of the most common types of mental health outcomes reported in the workplace. Burnout results from the effects of high job demands such as time pressures to complete work tasks and history of being monitored for performance creating chronic stress and emotional exhaustion. Burnout also serves as a mediator that links the relationship between job demands and outcomes (i.e., risky behaviours, intentions to leave the job and the use of unhealthy coping methods) (Nguyen-Phuoc et al., 2023; Liu et al., 2024; Zhan and Su, 2025; Li et al., 2024). Customer-related stressors contribute to this relationship as well because verbal abuse by customers and the requirement for emotional labour are both sources of psychological strain (Liu et al., 2026). This makes burnout an important outcome itself and an important pathway to which broader behavioural outcomes may be influenced.
 
Theme 4: Psychological well-being, resilience and the ambivalence phenomenon
 
Out of the 30 studies, 39.5% of the studies suggest a paradox in which workers experience moderate or positive levels of well-being even though they experience precarious working conditions. The ambivalence phenomenon (Wu et al., 2022) is supported through perceived autonomy (i.e., control over one’s work), flexibility and meaningful work. Workers often place a high value on their independence and receive support from their co-workers to help them deal with negative experiences (Svagan, 2023). Positive social connection and engagement with the work environment can contribute to high levels of well-being as well (Miszczynski and Pieczka, 2025; Lin et al., 2025). The workers’ ability to maintain their level of well-being demonstrates their ability to adapt to these stressful conditions, rather than indicating a lack of structural challenges.
 
Theme 5: Occupational safety and the mental health-safety nexus
 
There are 10 studies (13.2%) that show a significant association between the state of one’s mental health and the level of their physical safety. When someone’s mental health is poor, specificially through experiences of burnout, stress and fatigue, they are more likely to engage in risky behaviours while working as well as be involved in accidents. Burnout mediates the relationship between job demand and unsafe driving (Nguyen-Phuoc et al., 2023), while stress contributes to cognitive distraction and crash involvement. Fatigue also mediates the relationship between stress and accidents, while channeling monitoring can indirectly exacerbate these risks through increasing psychological strain (Chen and Wang, 2026).
 
Theme 6: Customer incivility and emotional labour
 
Eight studies (10.5%) found that interactions with customers can be a major source of stress and often this is overlooked stressful and can have a considerable effect on emotional exhaustion, verbal abuse and lack of flexibility. Workers have to use emotional labour to manage their emotions; this can be done by not expressing their feelings for the sake of upholding the service. The role of coping strategies is significant, with high levels of emotional suppression causing excessive exhaustion, while cognitive reappraisal will aid in recovery from emotional exhaustion (Liu et al., 2026). Failing to provide recognition and dignity can contribute to feelings of dissatisfaction and perceived injustice (Tiwari et al., 2024).
 
Theme 7: Work-life balance, social isolation and gender
 
Seven pieces of research (9.2%) look at wider societal issues such as working together-balancing home and work life and ssocial isolation. Although it has been said that flexible working is offered to employees, many find themselves in a situation where their ability to work flexibly has been restricted, resulting in extended work periods and blurring of lines between professional and personal lives. This is a further burden on women who perform childcare duties (Han, 2025), while self-employed people report being less able to have balance between work and home. Spatial exclusion and delivery jobs create a sense of social isolation (Lata et al., 2025), as well as the concept of delivery depletion being a term used to describe the build-up of exhaustion resulting from agent repetitively performing similar tasks over time (Moya and Casas-Cortés, 2025).
 
Integrative conceptual framework
 
As shown in Integrating all seven underlying themes into an overall conceptual framework, Fig 4 illustrates an integrative approach to mental health by combining the job demands-resources (JD-R) model, self-determination theory, conservation of resources theory and labour process theory together to identify eight structural antecedents associated with food delivery gig work (since app-based food delivery work has grown exponentially in recent years).  The focus of this framework is not on the individual’s vulnerability but on the structural conditions that create mental health outcomes for gig workers. 
       
Eight structural antecedents within food delivery gig work are identified in this framework: algorithmic control, income precarity, overload of work, social isolation, incivility from customers, physical risks, barriers due to a person’s gender and lack of social protection from physical or financial harm.  All of these antecedents are interconnected conditions of the platform business model, where risk is transferred to gig workers while algorithmic control remains with the company (De Stefano, 2016; Kougiannou and Mendonça, 2025). Together, these stressors form a cumulative interaction. For example, financial insecurity increases algorithmic pressure, whereas social isolation decreases the ability of an individual to cope with stress and the effect of mental fatigue may increase exposure to physical risks.
       
The antecedents described above work through four main psychological mechanisms. The JD-R Depletion Pathway analyses how workers are exhausted both cognitively and emotionally by excessive demands placed on them (Bakker and Demerouti, 2017; Liu et al., 2024; Nguyen-Phuoc et al., 2023). The Self Determination Theory analyses how algorithmic control undermines workers’ autonomy, competence and relatedness (Zhang et al., 2025). Relative deprivation is produced by perceived unfairness of the algorithm (Zhang et al., 2025; Zhao et al., 2025). Finally, while there are many other causes of emotional labour and maladaptive coping, workers’ interactions with customers are not being well managed (Liu et al., 2026; Chi et al., 2025).
       
The outcome variables are burnout, depression, anxiety and occupational stress and decreased quality of life, job dissatisfaction and work-life imbalance (Long et al., 2025). All of these variables can lead to behavioural outcomes, such as risky driving and accidents, deviant behaviour and turnover (Nguyen-Phuoc et al., 2023; Chen and Wang, 2026; Chi et al., 2025; Zhan and Su, 2025; Liu et al., 2024).
       
Moderating resources, such as social support, autonomy, resilience and organisational support can be used to mitigate the negative impact of the outcomes identified above. Although these moderating resources do not resolve structural problems, they do provide protection and will suggest key points for intervention that can improve gig worker well-being showed in Table 4 (Wu et al., 2022; Weber et al., 2025; Lin et al., 2025).

Table 4: Thematic and category factor alignment: Antecedents, mechanisms, outcomes and moderators.


       
Food delivery workers face significant mental health issues due to platform work’s structural elements, including piece rates, algorithmic management, ambiguous employment status and limited social support. These elements shift the economic and occupational hazards from the employer to the employee, generating instability, vulnerability and pressure for constant performance for the employee. This can lead to a variety of chronic stressors and a decrease in mental health and well-being among workers (Apouey et al., 2020; Long et al., 2025; Zhang et al., 2025; Zhao et al., 2025). While some individual resources can help to mitigate the effects of these structural and workplace conditions, e.g., social support, resilience and mindfulness, they primarily buffer effects, rather than change the structural and workplace conditions (Wu et al., 2022; Weber et al., 2025). Regional differences also shape the experience of workers, with geographical differences in labour laws, welfare systems and social security leading to different responses to platform-related stressors. This highlights the importance of developing regionally specific interventions. Key strategies include improving understanding of worker ratings through greater transparency, providing minimum wage protections for all workers and providing social security benefits. In addition, networks of peer support for workers, gender-based workplace policies and access to mental health care services are critical (Zhao et al., 2025; Kwangsukstith et al., 2025).Worker mental health, as a result of a poorly designed structural system, has a significant effect on the quality and safety of services and, subsequently, the reliability of services, which highlights the critical importance of improving worker health for food_security sustainability.
 
Limitations and future research

There are numerous limitations to this review, which should be taken into account in the interpretation of these results. The inclusion of only english-language studies means research from large gig economies such as China, Vietnam, Korea, India and Brazil may have been missed. Furthermore, a lack of an author keyword on many records in the Web of Science might limit the depth of the keyword and thematic analysis as well. Furthermore, most of the studies are cross-sectional in design and only record data at a single point in time, preventing any indication of the causal relationship between algorithmic control, financial stress and mental health. Longitudinal studies are required in order to gain an understanding of the relationships over time. Furthermore, the use of published findings rather than original data from worker participants for thematic analysis may not be an accurate representation of workers’ experiences. Finally, while duplicate records should have been removed, verification through manual inspection was not performed on all records and may result in some minor incorrect records.
               
Due to these limitations, future research should focus on longer-term mental health outcomes through longitudinal and real-time studies. Experimental studies testing useful interventions, such as fair pay systems; larger-scaled studies with a focus on gender and across multiple countries, including the aforementioned areas, would be useful.

CONCLUSION

This research provides an in-depth analysis of the literature concerning the mental health and well-being of gig economy restaurant delivery workers through both a systematic review of research published from 2020 through 2026 and through a thematic analysis of 76 articles included in the systematic review. The rapid growth of research findings during this time period demonstrates that the global community is focusing on the problems associated with platform work within the food delivery sector. Findings demonstrate that many issues faced by gig delivery workers are a result of structural issues. Structural issues identified include restrictions imposed by algorithmic control creating no real autonomy, unstable incomes leading to financial stress, lack of social supports, difficult customer interactions leading to stress and stress due to short delivery times leading to safety concerns. The study also demonstrates some workers maintain a sense of well-being despite experiencing these difficulties through personal resilience and social support; however, being able to cope in difficult work situations is not an adequate measure of employee well-being, but rather an indication of employees’ ability to adapt to a challenged work environment. The study identifies seven themes and develops a conceptual framework that can be utilized to further investigate gig economy workers, as well as inform policy and practice.

ACKNOWLEDGEMENT

The present study was supported by Symbiosis Institute of Business Management Nagpur. The authors sincerely acknowledge the guidance and support provided by Dr. Smruti Patre throughout the research process. The authors also express their gratitude to the reviewers and editorial team for their valuable comments and constructive suggestions, which significantly helped in improving the quality of the manuscript.
 
Disclaimers
 
The views and conclusions expressed in this article are solely those of the authors and do not necessarily represent the views of their affiliated institutions. The authors are responsible for the accuracy and completeness of the information provided, but do not accept any liability for any direct or indirect losses resulting from the use of this content.
 
Informed consent
 
No animals were used in the present study and therefore ethical approval related to animal experimentation was not required. All authors have read and approved the final manuscript and consent to its submission and publication.

CONFLICT OF INTEREST

The authors declare that there are no conflicts of interest regarding the publication of this article. No funding or sponsorship influenced the design of the study, data collection, analysis, decision to publish, or preparation of the manuscript.

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    ABSTRACT

    The rise in popularity of apps for food delivery services has led to a gig economy with many people in temporary jobs working under an algorithm; these jobs have unstable pay and lack job security. There have been numerous studies on mental health of gig workers; however, studies remain fragmented in size and scope. In order to fill the gap of knowledge about the mental health of gig workers, the researchers will combine two different methods of analysis (A systematic literature review and a textual thematic analysis) to create a comprehensive understanding of the mental health of gig workers, primarily in Asia. The researchers conducted a structured search of the Web of Science and Scopus databases for peer-review articles between 2020 and 2026 and located 111 studies that met inclusion criteria after the data was screened. A bibliometric analysis and a thematic analysis were employed to identify seven themes: algorithmic control, income stability/instability, job stress and burnout, psychological well-being, safety risks, customer-related stress and work-life issues. The findings of this study indicate that mental illness is primarily caused by structural working conditions, as opposed to personal factors. The authors conclude that there is a need for transparency in algorithms used to determine pay rates, competitive wages for gig workers, social protections for gig workers and overall improvements to occupational health for gig workers; the authors have also created a framework for possible future research and policy development on this topic.

    INTRODUCTION

    In the last ten years, digital food delivery firms grew quickly and created a large and constantly expanding number of gig workers who are critical to the functioning of urban food systems today. Gig workers deliver food for companies like Zomato, Swiggy, Meituan and Uber Eats and their work is organized via algorithms that track performance, deliver tasks and determine payments. This gig work model allows flexibility, but it also comes with many significant challenges. For example, gig workers often face unstable pay due to constant time constraints, low job security and no benefits. Ultimately, these challenges can lead to significant financial tension, social isolation and safety concerns for many gig workers, which negatively impacts their mental health and overall well-being (De Stefano, 2016; Li, 2026). Following the COVID-19 pandemic, these challenges are even more pronounced. During the pandemic, demand for food delivery services surged, which made gig workers essential to day-to-day life (Kose et al., 2022). Despite having an insecure job and poor health-safety measures being in place for most gig-workers, they were required to complete their work during this time frame (Apouey et al., 2020). As a result of all of this, research related to gig worker mental health has increased across various fields including: occupational health; management and; labour studies. However, there is no clear or comprehensive synthesis of the available evidence due to the wide range and limited coordination of research efforts on gig worker mental health. To fill the knowledge gap between research and the challenges that gig economy workers experience through mental illness in their workplace. Three specific objectives will be accomplished through the combined method of a systematic literature review with textual thematic analysis (TTA). The systematic literature review identifies the structure and trends of current literature including publication rates, geographic locations and methodologies, while TTA identifies key themes and patterns related to the findings. Three general objectives guide this research through six research questions (Bajaj and Sharma, 2024). The first three research questions (RQ1-RQ3) identify the trends, contributors and keywords in the literature, whereas the last three research questions (RQ4-RQ6) will examine worker well-being through reviewing mental health outcomes, identify factors that influence those outcomes and potential interventions that may support worker well-being. The focus of this study is to support the united nations sustainable development goals (SDGs). this study supports SDG 3: Good health and well-being, SDG 8: Decent work and economic growth and SDG 10: Reduced Inequalities, by demonstrating how workers in the gig economy face challenges with respect to mental health and solutions for creating safe, equitable and sustainable and decent working conditions for gig economy and food delivery workers (Rasoli et al., 2021).
     
    Theoretical background
     
    Using a variety of common theories to understand food delivery gig workers’ experience, the theories collectively illustrate the complexity and stress of working in such an environment. The JD-R Model indicates that stress develops when job demands are high and lack adequate support and resources (Bakker et al., 2017). In gig work, food delivery gigs have a high volume of demand; workers are continually required to meet deadlines and are subjected to app-based monitoring by customers. In addition to high demand this type of work has reliability issues; work is purely dependent on a worker being able to access the app and produce enough income for cost-of-living expenses. Self-Determination Theory provides an additional explanation; for people to be fully motivated and feel satisfied with their work, they need three component parts of their job; autonomy, competence and social relationship. Although many of the advertisements for gig work suggest there is great flexibility, in reality, there is a high reliance on ratings, penalties and isolation to create a false sense of freedom diminishing the ability to experience true freedom due to what is known as the “autonomy paradox” as theorized by Deci et al., (1985).
           
    Labour Process Theory adds insight into the issue of how platform companies reduce costs by transferring risks from themselves to workers through contract-type employment and/or algorithmic types of control (Braverman, 1974). “Conservation of resources theory” demonstrates that losing valuable resources can cause an increase in stress (Hobfoll, 1989) i.e., wage stability, social support. Finally, “Transactional model of stress” illustrates that how an individual perceives and copes with the stressors can determine their overall response (Lazarus and Folkman, 1984).
           
    This research uses a specific kind of research: Multiple studies (MS)-and combines two different methodologies: Systematic literature review (SLR) and Textual thematic analysis (TTA) (Braun and Clarke, 2019). Systematic literature reviews provide transparency, reproducibility and complete coverage of all evidence; whereas textual thematic analyses are active analytical interpretation and creative construction of concepts based on data. The combination of both SLRs and TTAs in this review allows for both understanding the total number, distribution and quality of evidence available as well as creating theme based on the data that is more than simply descriptive.
     
    Systematic literature review
     
    Database selection and search strategy
     
    To find relevant literature and studies regarding gig and platform workers, a structured Boolean search strategy using the appropriate terminology in conjunction with the multi-disciplinary databases Web of science (WoS) core collection and scopus was completed as both of these databases are comprehensive in providing coverage from all major research areas including management, psychology, occupational health and social sciences (Bounoua et al., 2025).
           
    The search strategy was based on three groups of key concepts that were connected using the boolean operator “AND”. The first group of key concepts included gig and platform workers (e.g., gig worker, delivery riders, app-based workers, couriers) and the second group included the context of food delivery (e.g., online food delivery, meal delivery, last mile delivery). The third group included mental health outcomes as they relate to gig workers (e.g., stress, burnout, anxiety, job satisfaction, well-being) within the above-defined parameters.
           
    The Boolean search was conducted on titles, abstracts and author-supplied keywords using wildcard characters (*) for the various term variations. There were no restrictions placed at this stage on either document type or subject area to ensure exhaustive coverage of gig and platform workers in the food delivery sector. From WoS there were 44 records and from Scopus there were 67 records for a total of 111 records.
     
    Eligibility criteria
     
    Following PRISMA guidelines (Page et al., 2021), predefined inclusion and exclusion criteria were applied during title, abstract and full-text article assessed summarised in Table 1. Studies were included if they focused on food delivery or platform gig workers, reported at least one mental health or well-being outcome, were published in English and fell within the 2020-2026 period. Studies focusing solely on logistics, customer experience, or physical health without psychological aspects were excluded, along with editorials, dissertations and non-peer-reviewed works (Mehta et al., 2025). A total of 111 records were identified from web of science (44) and Scopus (67). After merging datasets, duplicate removal was conducted based on DOI normalization, eliminating 25 records, followed by an additional 10 unmatched records removed using title checks. This resulted in 76 eligible studies for final analysis, as outlined in the PRISMA 2020 Flowchart (Fig 1).

    Table 1: Inclusion and exclusion criteria for study selection (PRISMA 2020).



    Fig 1: PRISMA 2020 flow diagram illustrating record identification, deduplication, screening, eligibility assessment and inclusion stages.


     
    Textual thematic analysis
     
    In this research, the analysis themes were done using Braun and Clarke’s six-step method (2006, 2019) to analyse. The first step was for the researchers to read through the data several times, becoming familiar with them, looking at the abstracts of all 76 studies and their findings and conclusions to achieve this. The next step was to identify and systematically code the significant patterns within the text. Each theme name was then defined meaningfully and distinctly through ongoing writing and reflection. After defining the name of each theme, they were organised and presented within the overall narrative of the systematic reviews. In this work, we take a critical realist view that recognises a researcher’s view will shape the resulting themes, but that the themes are also created from the real-world experiences of gig workers (Rathod et al., 2025).
           
    The point of saturation occurred after approximately 58 studies were analysed as similar themes were found within the data set post the point of saturation. The final structure consisted of seven validated themes which were validated against the total data set before being presented.
     
    Publication trends
     
    An examination of 76 published works from 2020-2026 indicates a rapid increase in research on mental health for the new category of “food delivery gig worker” and provides evidence of increasing academic and policy interest in this area. From 2020-2025, the number of studies published in the field rose from 5 to 27 and in particular, both 2022 and 2023 saw a significant increase in the number of studies published (6 and 10 respectively). The majority of studies published in 2020/2021 focused on logistics and consumer behaviour opens doors for more studies focused on the mental health of these workers. Between 2023 and 2024, there was the most dramatic increase in publication output, with an increase of 18 studies due to an increased interest from the public, media and policymakers with a focus on Asia. The greatest number of studies published during any given year was 2025 when 27 studies were published. After the end of March, 2026, there will already have been 8 studies published indicating this area will continue to have significant growth in research output illustrated in Fig 2.

    Fig 2: Annual (bars) and cumulative (line) publication output for studies on food delivery gig worker mental health and well-being, 2020-2026 (N = 76).


     
    Geographic distribution and disciplinary reach
     
    The vast majority of gig worker mental health research is done in Asia, comprising over 57% (Yoo et al., 2024). The highest rate of research is being conducted in China, followed by South Korea, Vietnam, India, Malaysia and Hong Kong presented in Fig 3. This trend illustrates the fast-growing number of food delivery platforms in Asia and the need to study workers’ conditions in regions with little social safety net protection. There are great alternative regional research approaches. For example, the majority of Chinese research on gig workers is quantitative, focused on algorithmic control and emphasizes issues such as burnout, stigma and turnover based on platform data. On the other hand, Vietnamese research is focused largely on the area of occupational health and road safety due to high levels of motorcycle use in Vietnam. Finally, research from India focuses on gig workers’ experiences on platforms such as Zomato and Swiggy, focusing on the nature of management practices and worker welfare. Alternatively, a small amount of research conducted in Brazil and Europe provides alternative frameworks regarding the fields of public health and food security.

    Fig 3: Geographic distribution of included studies by primary country of data collection (N = 76).


     
    Methodological distribution
     
    A large number of studies (58%) have used quantitative methods, which tend to be cross-sectional in nature (i.e., they only look at a single point in time). While there is a large number of studies that have used qualitative methods (33% of the studies in this literature), these studies provide more in-depth contextual information about the data. Mixed-methods studies make up a very small percentage of the studies published in this field (7%), despite their potential contribution to a more thorough understanding of the topic.
     
    Leading journals and authors
     
    There were 76 studies located throughout more than 60 journals which indicated that research for this area is interdisciplinary. A limited number of journals accounted for two studies each and they include: Safety science (Safety science), safety and health at work, frontiers in psychology (Frontiers psychology), BMC psychology (BMC psychology) Employee relations (Employee relations), service industries journal (Service industries) and international journal of hospitality management (IHOM) and research in transportation business and management (RTB) which span a range of different disciplines including health, psychology, management, transportation and Hospitality. Hence the research for gig worker mental health has not yet defined a dedicated outlet in which it can be published as a distinct line of work has not developed. With respect to authorship, the most prolific contributor is Nguyen-Phuoc (Vietnam) with 4 studies focused on burnout, job demands and road safety. Other significant contributors include; Zhang (China), Daufenback (Brazil), Kesane and Spurina (Latvia) whose studies investigate algorithmic control, working conditions, autonomy and inequality. The most influential study to date is Apouey et al., (2020), which has been cited most frequently, is the most notable study to establish a clear link between financial instability (i.e., due to COVID-19) and mental well-being and Nguyen-Phuoc et al., (2023) which measured the association between occupational stress and unsafe driving behaviour. Table 2 provides a summary of the main characteristics of these studies.

    Table 2: Characteristics of key included studies selected to represent the corpus (n = 9; full extraction in supplementary material S1).


     
    Keyword Co-occurrence and thematic clusters
     
    The analysis of author-provided keywords, limited to studies that actually reported them, revealed five clear thematic clusters across the dataset. The most commonly used terms included “gig economy” (8 occurrences), followed by “food delivery” (4) and “well-being,” “job satisfaction,” “platform work,” “algorithmic management,” and “gig work” (3 each). Other recurring terms such as “job stress,” “emotional exhaustion,” “algorithmic control,” “food delivery rider,” and “safety” appeared less frequently (2 each).
           
    A noticeable pattern emerges from how these keywords appear together. Terms related to algorithmic management and control are often closely linked with those describing stress, burnout and emotional exhaustion. This pattern supports the broader findings of the review, suggesting that platform-based algorithmic systems act as a key source of pressure, which in turn leads to negative psychological outcomes for gig workers.
     
    Thematic analysis
     
    Based on the thematic analysis of the 76 selected studies, seven main themes were developed. The themes are summarised Table 3 and further elaborated in the next sections. The themes were created from an interpretive approach which provided insight into the deeper emerging patterns that cross over different methodologies, disciplines and country contexts, in order to develop the themes. All of the themes were connected, rather than being individual. Many studies contributed to more than one theme, which is indicative of how complex and overlapping gig workers’ experiences are. An example of how studies relate to the various themes is illustrated in Table 3 and an overview of how all the seven themes relate is shown in Fig 4.

    Table 3: Thematic synthesis: Seven overarching themes constructed from textual thematic analysis (N = 76 studies).


     

    Fig 4: Integrative conceptual framework synthesising antecedents, mediating mechanisms, moderating resources and mental health outcomes for food delivery platform gig workers (N = 76 studies).



    Theme 1: Algorithmic control and the autonomy paradox
     
    The study of 21 studies suggests a major contradiction about platform work: although it is supposed to provide flexibility, there are various control mechanisms (e.g., real-time management via algorithms and rating systems) that produce high levels of burnout and dissatisfaction amongst workers; therefore, they identify a lack of perceived equity and transparency, which, in turn, reinforces these negative feelings. In addition to some workers receiving support in the form of coping strategies, groups and collective support/building a shared understanding amongst other workers are seen to be helpful in combating the effects of high levels of control. Furthermore, high levels of control can also lead to deviance and lower overall platform effectiveness, as algorithms are often seen to reduce both worker well-being and organisation outcomes.
     
    Theme 2: Income precarity, structural vulnerability and financial stress
     
    There are 20 studies (26.3%) that identify income insecurity as a major contributor to poor mental health. Gig workers often have unstable earnings, do not receive benefits and have little to no access to social protective services. Financial uncertainty appears to be linked with decreased well-being (Apouey et al., 2020); on the other hand, the absence of social insurance has been shown to significantly increase the risk of developing major depressive disorder (depression) (Long et al., 2025). In addition, there are more prominent structural inequalities related to the platform economy as evidenced by cases where workers exhibit food insecurity but are employed in the business of delivering food the algorithms used by platforms tend to prioritize efficiency over worker welfare, placing workers and platforms at greater systemic risk than they already are (Li, 2026). Therefore, these studies suggest that financial instability is not only an individual level problem but also at the systemic or structural level.
     
    Theme 3: Job stress, burnout and emotional exhaustion
     
    A total of 24 studies (31.6% of total studies) found that burnout was one of the most common types of mental health outcomes reported in the workplace. Burnout results from the effects of high job demands such as time pressures to complete work tasks and history of being monitored for performance creating chronic stress and emotional exhaustion. Burnout also serves as a mediator that links the relationship between job demands and outcomes (i.e., risky behaviours, intentions to leave the job and the use of unhealthy coping methods) (Nguyen-Phuoc et al., 2023; Liu et al., 2024; Zhan and Su, 2025; Li et al., 2024). Customer-related stressors contribute to this relationship as well because verbal abuse by customers and the requirement for emotional labour are both sources of psychological strain (Liu et al., 2026). This makes burnout an important outcome itself and an important pathway to which broader behavioural outcomes may be influenced.
     
    Theme 4: Psychological well-being, resilience and the ambivalence phenomenon
     
    Out of the 30 studies, 39.5% of the studies suggest a paradox in which workers experience moderate or positive levels of well-being even though they experience precarious working conditions. The ambivalence phenomenon (Wu et al., 2022) is supported through perceived autonomy (i.e., control over one’s work), flexibility and meaningful work. Workers often place a high value on their independence and receive support from their co-workers to help them deal with negative experiences (Svagan, 2023). Positive social connection and engagement with the work environment can contribute to high levels of well-being as well (Miszczynski and Pieczka, 2025; Lin et al., 2025). The workers’ ability to maintain their level of well-being demonstrates their ability to adapt to these stressful conditions, rather than indicating a lack of structural challenges.
     
    Theme 5: Occupational safety and the mental health-safety nexus
     
    There are 10 studies (13.2%) that show a significant association between the state of one’s mental health and the level of their physical safety. When someone’s mental health is poor, specificially through experiences of burnout, stress and fatigue, they are more likely to engage in risky behaviours while working as well as be involved in accidents. Burnout mediates the relationship between job demand and unsafe driving (Nguyen-Phuoc et al., 2023), while stress contributes to cognitive distraction and crash involvement. Fatigue also mediates the relationship between stress and accidents, while channeling monitoring can indirectly exacerbate these risks through increasing psychological strain (Chen and Wang, 2026).
     
    Theme 6: Customer incivility and emotional labour
     
    Eight studies (10.5%) found that interactions with customers can be a major source of stress and often this is overlooked stressful and can have a considerable effect on emotional exhaustion, verbal abuse and lack of flexibility. Workers have to use emotional labour to manage their emotions; this can be done by not expressing their feelings for the sake of upholding the service. The role of coping strategies is significant, with high levels of emotional suppression causing excessive exhaustion, while cognitive reappraisal will aid in recovery from emotional exhaustion (Liu et al., 2026). Failing to provide recognition and dignity can contribute to feelings of dissatisfaction and perceived injustice (Tiwari et al., 2024).
     
    Theme 7: Work-life balance, social isolation and gender
     
    Seven pieces of research (9.2%) look at wider societal issues such as working together-balancing home and work life and ssocial isolation. Although it has been said that flexible working is offered to employees, many find themselves in a situation where their ability to work flexibly has been restricted, resulting in extended work periods and blurring of lines between professional and personal lives. This is a further burden on women who perform childcare duties (Han, 2025), while self-employed people report being less able to have balance between work and home. Spatial exclusion and delivery jobs create a sense of social isolation (Lata et al., 2025), as well as the concept of delivery depletion being a term used to describe the build-up of exhaustion resulting from agent repetitively performing similar tasks over time (Moya and Casas-Cortés, 2025).
     
    Integrative conceptual framework
     
    As shown in Integrating all seven underlying themes into an overall conceptual framework, Fig 4 illustrates an integrative approach to mental health by combining the job demands-resources (JD-R) model, self-determination theory, conservation of resources theory and labour process theory together to identify eight structural antecedents associated with food delivery gig work (since app-based food delivery work has grown exponentially in recent years).  The focus of this framework is not on the individual’s vulnerability but on the structural conditions that create mental health outcomes for gig workers. 
           
    Eight structural antecedents within food delivery gig work are identified in this framework: algorithmic control, income precarity, overload of work, social isolation, incivility from customers, physical risks, barriers due to a person’s gender and lack of social protection from physical or financial harm.  All of these antecedents are interconnected conditions of the platform business model, where risk is transferred to gig workers while algorithmic control remains with the company (De Stefano, 2016; Kougiannou and Mendonça, 2025). Together, these stressors form a cumulative interaction. For example, financial insecurity increases algorithmic pressure, whereas social isolation decreases the ability of an individual to cope with stress and the effect of mental fatigue may increase exposure to physical risks.
           
    The antecedents described above work through four main psychological mechanisms. The JD-R Depletion Pathway analyses how workers are exhausted both cognitively and emotionally by excessive demands placed on them (Bakker and Demerouti, 2017; Liu et al., 2024; Nguyen-Phuoc et al., 2023). The Self Determination Theory analyses how algorithmic control undermines workers’ autonomy, competence and relatedness (Zhang et al., 2025). Relative deprivation is produced by perceived unfairness of the algorithm (Zhang et al., 2025; Zhao et al., 2025). Finally, while there are many other causes of emotional labour and maladaptive coping, workers’ interactions with customers are not being well managed (Liu et al., 2026; Chi et al., 2025).
           
    The outcome variables are burnout, depression, anxiety and occupational stress and decreased quality of life, job dissatisfaction and work-life imbalance (Long et al., 2025). All of these variables can lead to behavioural outcomes, such as risky driving and accidents, deviant behaviour and turnover (Nguyen-Phuoc et al., 2023; Chen and Wang, 2026; Chi et al., 2025; Zhan and Su, 2025; Liu et al., 2024).
           
    Moderating resources, such as social support, autonomy, resilience and organisational support can be used to mitigate the negative impact of the outcomes identified above. Although these moderating resources do not resolve structural problems, they do provide protection and will suggest key points for intervention that can improve gig worker well-being showed in Table 4 (Wu et al., 2022; Weber et al., 2025; Lin et al., 2025).

    Table 4: Thematic and category factor alignment: Antecedents, mechanisms, outcomes and moderators.


           
    Food delivery workers face significant mental health issues due to platform work’s structural elements, including piece rates, algorithmic management, ambiguous employment status and limited social support. These elements shift the economic and occupational hazards from the employer to the employee, generating instability, vulnerability and pressure for constant performance for the employee. This can lead to a variety of chronic stressors and a decrease in mental health and well-being among workers (Apouey et al., 2020; Long et al., 2025; Zhang et al., 2025; Zhao et al., 2025). While some individual resources can help to mitigate the effects of these structural and workplace conditions, e.g., social support, resilience and mindfulness, they primarily buffer effects, rather than change the structural and workplace conditions (Wu et al., 2022; Weber et al., 2025). Regional differences also shape the experience of workers, with geographical differences in labour laws, welfare systems and social security leading to different responses to platform-related stressors. This highlights the importance of developing regionally specific interventions. Key strategies include improving understanding of worker ratings through greater transparency, providing minimum wage protections for all workers and providing social security benefits. In addition, networks of peer support for workers, gender-based workplace policies and access to mental health care services are critical (Zhao et al., 2025; Kwangsukstith et al., 2025).Worker mental health, as a result of a poorly designed structural system, has a significant effect on the quality and safety of services and, subsequently, the reliability of services, which highlights the critical importance of improving worker health for food_security sustainability.
     
    Limitations and future research

    There are numerous limitations to this review, which should be taken into account in the interpretation of these results. The inclusion of only english-language studies means research from large gig economies such as China, Vietnam, Korea, India and Brazil may have been missed. Furthermore, a lack of an author keyword on many records in the Web of Science might limit the depth of the keyword and thematic analysis as well. Furthermore, most of the studies are cross-sectional in design and only record data at a single point in time, preventing any indication of the causal relationship between algorithmic control, financial stress and mental health. Longitudinal studies are required in order to gain an understanding of the relationships over time. Furthermore, the use of published findings rather than original data from worker participants for thematic analysis may not be an accurate representation of workers’ experiences. Finally, while duplicate records should have been removed, verification through manual inspection was not performed on all records and may result in some minor incorrect records.
                   
    Due to these limitations, future research should focus on longer-term mental health outcomes through longitudinal and real-time studies. Experimental studies testing useful interventions, such as fair pay systems; larger-scaled studies with a focus on gender and across multiple countries, including the aforementioned areas, would be useful.

    CONCLUSION

    This research provides an in-depth analysis of the literature concerning the mental health and well-being of gig economy restaurant delivery workers through both a systematic review of research published from 2020 through 2026 and through a thematic analysis of 76 articles included in the systematic review. The rapid growth of research findings during this time period demonstrates that the global community is focusing on the problems associated with platform work within the food delivery sector. Findings demonstrate that many issues faced by gig delivery workers are a result of structural issues. Structural issues identified include restrictions imposed by algorithmic control creating no real autonomy, unstable incomes leading to financial stress, lack of social supports, difficult customer interactions leading to stress and stress due to short delivery times leading to safety concerns. The study also demonstrates some workers maintain a sense of well-being despite experiencing these difficulties through personal resilience and social support; however, being able to cope in difficult work situations is not an adequate measure of employee well-being, but rather an indication of employees’ ability to adapt to a challenged work environment. The study identifies seven themes and develops a conceptual framework that can be utilized to further investigate gig economy workers, as well as inform policy and practice.

    ACKNOWLEDGEMENT

    The present study was supported by Symbiosis Institute of Business Management Nagpur. The authors sincerely acknowledge the guidance and support provided by Dr. Smruti Patre throughout the research process. The authors also express their gratitude to the reviewers and editorial team for their valuable comments and constructive suggestions, which significantly helped in improving the quality of the manuscript.
     
    Disclaimers
     
    The views and conclusions expressed in this article are solely those of the authors and do not necessarily represent the views of their affiliated institutions. The authors are responsible for the accuracy and completeness of the information provided, but do not accept any liability for any direct or indirect losses resulting from the use of this content.
     
    Informed consent
     
    No animals were used in the present study and therefore ethical approval related to animal experimentation was not required. All authors have read and approved the final manuscript and consent to its submission and publication.

    CONFLICT OF INTEREST

    The authors declare that there are no conflicts of interest regarding the publication of this article. No funding or sponsorship influenced the design of the study, data collection, analysis, decision to publish, or preparation of the manuscript.

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