US Workers' Self-Reported Mental Health Outcomes by Industry and Occupation

Abstract

Importance: Work-related hazards and stress have been shown to be associated with mental health, with suicide rates among adult workers increasing since 2000.

Objective: To determine if self-reported lifetime diagnosed depression, frequent mental distress (FMD), extreme distress prevalences, and mean mentally unhealthy days (MUD) varied among current workers by industry or occupation.

Design, setting, and participants: This cross-sectional study used Behavioral Risk Factor Surveillance System (BRFSS) data from 37 states reporting workers' industry and occupation in 1 or more years between 2015 and 2019. The target population was currently employed civilian adults aged 18 years or older. Analyses were conducted in 2022 and 2023.

Exposures: Workers' current industry and occupation were the primary exposures of interest. Self-reported sociodemographic covariates included sex, age, race and ethnicity, education, coupled status, and health care coverage.

Main outcomes and measures: Self-reported lifetime diagnosed depression, FMD, extreme distress, and MUD.

Results: Of a total 536 279 workers assessed (unweighted sample, 535 997 workers; 263 007 female [49.1%]; 48 279 Hispanic [9.0%], 40 188 non-Hispanic Black [7.5%], 400 604 non-Hispanic White [74.7%]), 469 129 reported their industry or occupation. Lifetime diagnosed depression was reported by 80 319 of 534 342 workers (14.2% [95% CI, 13.9%-14.4%]). Mean MUD was 9.5 days (95% CI, 9.4-9.7 days) among 530 309 workers, and in all sociodemographic groups the mean MUD was 3 to 5 times higher among workers who reported lifetime diagnosed depression. Higher prevalences than all workers for lifetime diagnosed depression, FMD, and extreme distress were reported by workers who were female (lifetime diagnosed depression, 19.5% [95% 19.1%-19.9%]; FMD, 11.6% [95% CI, 11.3%-11.9%]; extreme distress, 4.8% [95% CI, 4.6%-5.1%]), ages 18 to 34 years (lifetime diagnosed depression, 16.9% [95% CI, 16.4%-17.3%]; FMD, 13.6% [95% CI, 13.1%-14.0%]; extreme distress, 5.5% [95% CI, 5.2%-5.8%]), and no longer or never in a couple (lifetime diagnosed depression, 18.0% [95% CI, 17.6%-18.4%]; FMD, 13.3% [95% CI, 12.9%-13.7%]; extreme distress, 5.7% [95% CI, 5.4%-6.0%]). By industry, retail trade (lifetime diagnosed depression: APR, 1.15 [95% CI, 1.05-1.25]; FMD: APR, 1.23 [95% CI, 1.10-1.39]) and accommodation and food services (lifetime diagnosed depression: APR, 1.13 [95% CI, 1.03-1.25]; FMD: APR, 6.8 [95% CI, 6.0-7.7]) had higher adjusted prevalences of lifetime diagnosed depression and FMD. By occupation, arts, design, entertainment, sports, and media (1.32 [95% CI, 1.09-1.60]); health care support (1.19 [95% CI, 1.03-1.38]); food preparation and serving (1.20 [95% CI, 1.05-1.36]); and sales and related occupations (1.13 [95% CI, 1.01-1.27]) had higher adjusted prevalences of FMD than the comparison group. Health care support (6.6% [95% CI, 5.5%-7.8%]), food preparation and service (6.9% [95% CI, 5.9%-7.8%]), building and grounds cleaning and maintenance (5.2% [95% CI, 4.4%-6.0%]), personal care and service (5.8% [95% CI, 4.9%-6.8%]), and sales and related occupations (4.8% [95% CI, 4.3%-5.3%]) had higher unadjusted extreme distress than all workers.

Conclusions and relevance: In this cross-sectional study, poor mental health among workers varied significantly by sociodemographic categories; significant differences among industry and occupation groups remained after adjustment. More research is needed on the effects of work-related factors on mental health, which may inform tailored treatment and prevention strategies.