Anxious? Depressed? Blame it on your middle-management position

While social disadvantage related to income and educational attainment is associated with a higher risk of most adverse mental health outcomes, these latest findings show that people towards the middle of social hierarchies suffered higher rates of depression and anxiety based on their social class and position of power in the labor market.

"Contradictory class locations are those that embody aspects of both ownership and labor, and using this construct we found patterns of depression and anxiety that are not easily detected or explained with standard approaches," said first author Seth J. Prins, MPH, a doctoral student in Epidemiology at the Mailman School of Public Health and fellow in the Psychiatry Epidemiology Training Program. "We explored how social class might in?uence depression and anxiety in ways that may be masked or incompletely explained by standard socioeconomic status measures."

The researchers based their findings on the largest representative population data set ever used to test these hypotheses directly: the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative survey of the U.S. population age 18 and older, interviewed in person. This study used data on the 21, 859 participants who were full-time workers. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) Alcohol Use Disorder and Associated Disabilities Interview Schedule DSM-IV was used to assess DSM-IV psychiatric disorders.

The researchers estimated the prevalence and odds of any lifetime and previous 12-month depression and anxiety by occupational class categories, income, and education. Class designations were made by sorting respondents into three categories: owners, who identified as self-employed and earned greater than $71,500; managers and supervisors, who occupied executive, administrative or managerial positions; and workers, who were defined by various occupation categories in the NESARC including farmers and laborers.

"We chose to focus on depression and anxiety because the average age of onset is older than age 18, and these disorders are likely to arise after entry in the workforce," said Katherine Keyes, PhD, assistant professor of Epidemiology.

Prior research has shown that work stress and job strain are important risk factors in developing depression. Workers with little opportunity for decision-making and greater job demands show higher rates of depressive symptoms.

"Our findings highlight the need for population health research to both conceptualize and measure social class in ways that go beyond the standard measures of socioeconomic status," said Lisa M. Bates, ScD, assistant professor of Epidemiology, "Standard measures are most readily available, but can mask important complexity in the relationship between social class and population health."