Psychological distress is more common in some occupations and increases with job tenure: a thirty-seven year panel study in the United States | BMC Psychology

We studied associations of occupation with distress in the United States using nationally representative longitudinal data with repeated measures of occupation and psychological distress. We extended research in this area by focusing on new cases of distress following occupational exposures. Consistent with our first hypothesis, people with high risk occupations were significantly more likely to develop distress than those with low risk occupations [7, 16, 17, 22, 26, 28]. Given the variables for which we controlled, these risks are not likely due to characteristics of the workers or to nonoccupational distress risks—or not due only to them. Our results differed from the conclusions of a longitudinal study in Canada [30], which found little evidence linking most workplace factors with distress after controlling for non-occupational distress risks. However, that study and those of other researchers [7,8,9] did find evidence of a protective effect of social support at work for workers’ mental health.

We found a significant dose-response relationship between the number of years in a high risk occupation and distress. Consistent with our second hypothesis the odds of developing distress increased 5% with each additional year. This result was consistent with a metaanalysis linking tenure in high risk occupations with hospitalization for depression [12].

Consistent with our third hypothesis, participants who described positive job characteristics linked with the Job-Demand-Control-Support Model were significantly less likely than others to have high risk occupations. Participants who described negative job characteristics were significantly more likely to have high risk occupations. These results were consistent with researchers’ findings linking positive job resources (e.g., skill discretion, social support, and skill utilization) with a lower likelihood of depressive or anxiety symptoms [6,7,8,9,10].

Limitations and strengths

Occupations other than those that we studied might also have low or high risks for distress, particularly if researchers have not studied the distress risks of those occupations—in which case they would not be included in our analysis. Although we reviewed the relevant literature, conducting an exhaustive literature review or meta-analysis was beyond the scope of our study. Further, researchers have found mixed results for a number of occupations. For example, Wang and Rosenman (2018) [22] found that depression was higher among health care workers, whereas Cadieux and Marchand (2014) [23] found that psychological distress was significantly lower in health care professions. Mixed results across studies may be due to differences in study designs, data and controls, time periods, and locations. We acknowledge limited theory associating specific individual occupations with distress. The Job-Demand-Control-Support Model provided a relevant framework [11].

Consistent with many studies [e.g., 16, 17, 22, 26, 28], the PSID provided only limited measures of organizational characteristics that may be associated with distress. We could not distinguish risk factors of occupations (e.g., exposures to chemicals) from characteristics of employers and industries (e.g., those with large workforces). The data did not measure organizational factors that may contribute to variation in distress outcomes across firms within a given occupation, such as organizational culture, organizational structure (such as vertical, horizontal, or matrixed organizations), organizational life stage, characteristics of the organization’s leadership and decision-making, and worker access to organizational resources or job security. Participants lived throughout the United States; it is likely that those in any given occupation represented a range of employer and organizational characteristics.

The external environment can also affect the risk that workers will develop distress, as when a regional or national recession increases job loss, or when a period of economic inflation reduces real income, increases uncertainty, and strains relations between employers and workers. It is likely that this source of variation was addressed to some degree by the fact that the data spanned several decades and represented a variety of changing external environments, including economic cycles. That variety reduced the likelihood of bias that can occur when cross-sectional studies represent only a single data collection period and therefore may not represent organizations over time.

High risk occupations were generally blue collar jobs. Low risk occupations generally had higher social status, although that group included lower status occupations such as health aides. If the controls did not adequately adjust for workers’ socioeconomic characteristics the results could measure social stratification rather than occupational differences. However, controls included education, income, and health in childhood and midlife, all of which are linked with socioeconomic status. In general, research on the social gradient of health shows poorer self-rated health, more limited physical functioning, and more long sickness absence for people with blue collar jobs, compared to people with higher socio-economic status. However, the evidence regarding mental health is not so clear. White collar workers have reported higher psychological job demands, while blue collar workers reported higher physical demands [41]. Studies found a reverse gradient for mental health outcomes; people with lower socioeconomic status were less likely than those with higher status to experience stress and burnout symptoms [42], as well as a wide range of other psychiatric symptoms[43,44,45,46]. A longitudinal study of occupations and psychological distress found no evidence that blue collar workers had an elevated risk of distress [30].

The K6 cut-point of 13 identified serious mental illness with substantial impairment, meeting criteria for a Diagnosis and Statistical Manual IV disorder [19]. Distress below that cutpoint can also have serious health and economic impacts [20].

We measured occupational exposures based on participants’ reports of their principal occupation in each survey wave. Americans increasingly work in more than one occupation at a given time. It would be useful to study the impact of multiple occupational exposures on distress.

Our study also had several strengths: use of nationally representative panel data with extended follow-up, many measurements of occupation for most participants, repeated measures using a validated indicator of psychological distress, and the focus on the development of distress following occupational exposures. We controlled for many individual-level characteristics that may influence occupation options and workers’ choices to enter or remain in an occupation. The panel data allowed us to examine whether occupational distress risks increased with tenure in high risk occupations.

The extended follow-up may also be a limitation as the association of some occupations with distress might have changed across the study period. For example, in recent years it has been reported that many doctors, nurses, and teachers are dissatisfied with their jobs, particularly since the beginning of the COVID-19 pandemic. In the PSID from 1972, however, 92.6% of medical doctors, nurses, and teachers described their jobs as “very enjoyable” (29.6%), “mostly enjoyable” (48.2%), or “somewhat enjoyable” (14.8%). Also, in the period following the study years the unprecedented system shock caused by the COVID-19 pandemic may have altered links between some occupations and distress.

Linking high risk occupations and distress does not necessarily establish causation as other factors might contribute to distress. However, our use of an extended period of longitudinal data with many measurements of occupation and distress, our focus on the development of distress following occupational exposure, and the dose-response relationship of occupational exposure with distress that we found, all provide evidence consistent with causation.

Implications for practice and research

The Total Worker Health model at The National Institute for Occupational Safety and Health and The U.S. Surgeon General’s Framework for Workplace Mental Health and Well-being recognize the importance of promoting emotional wellbeing at work. The need is substantial and may be growing. In a 2021 survey of U.S. adult workers, 76% reported at least one mental health symptom, 17% points higher than two years earlier; 84% identified workplace factors as causes of their mental health problems [53]. More research is needed to test psychosocial work stress models using longitudinal data that ascertain mental health problems validly, provide adequate control for potential confounding, and include the measures required to test theory-based analytical models. Further research in this area may help employers develop effective strategies to promote a healthy and productive workforce.