Associations of Tipped and Untipped Service Work with Poor Mental Health in a Nationally Representative Cohort of Adolescents Followed into Adulthood

Abstract

Precarious work is concentrated in the service industry in the United States and is a risk factor for poor mental health. Service occupations in which workers receive tips are potentially more precarious due to unstable schedule, income, and lack of benefits. We tested hypotheses that individuals working in tipped service occupations have greater odds of experiencing poor mental health (self-reported depression, sleep problems, and/or greater perceived stress) relative to individuals in untipped service and non-service occupations using cross-sectional data from the National Longitudinal study of Adolescent to Adult Health dataset (Wave IV:2007-2008; age 24-33 years). To improve comparability of occupation types, propensity-scores were computed as a function of childhood factors, then used to construct a sample of 2,815 women and 2,586 men. In gender-stratified multivariable regression, women in tipped service had greater odds of reporting depression diagnosis or symptoms relative to women in non-service work (Odds Ratio:1.61; 95% Confidence Interval:1.11,2.34). Associations of similar magnitude for sleep problems and perceived stress were observed among women, but were not significant; all associations were close to the null among men. Further research is necessary to understand the factors that underlie differences in poor mental health in tipped and untipped service versus non-service workers.