Differences in work conditions such as job autonomy, job insecurity, and shift work may lead to health disparities in the population (1). Previous research has linked worse health outcomes to shift work (2–4), job insecurity (5), and other work conditions (6). This report uses 2021 National Health Interview Survey (NHIS) data to examine differences in serious psychological distress in the past 30 days by work conditions, including shift work, monthly earnings variation, perceived job insecurity, and work schedule flexibility, for working adults aged 18–64 in the United States.
What percentage of working adults experienced serious psychological distress in 2021, and did it differ by type of work shift?
- In 2021, 2.7% of working adults aged 18–64 experienced serious psychological distress (Figure 1).
- Serious psychological distress was higher among adults who usually worked the evening or night shift (4.8%) or a rotating shift (3.9%) compared with those who worked day shifts (2.3%).
Figure 1. Percentage of working adults aged 18–64 reporting serious psychological distress in the past 30 days, by type of work shift: United States, 2021
1Significantly different from those who worked evening or night shift (p < 0.05).
2Significantly different from those who worked rotating or other shift (p < 0.05).
NOTES: Serious psychological distress was determined by responses to the six questions comprising the Kessler 6 nonspecific distress scale. Serious psychological distress, defined as a score of 13 or higher on the scale, includes mental health problems severe enough to cause moderate-to-serious impairment in social and occupational functioning and to require treatment. Estimates are based on household interviews of a sample of the U.S. civilian noninstitutionalized population. Access data table for Figure 1.
SOURCE: National Center for Health Statistics, National Health Interview Survey, 2021.
Did serious psychological distress among working adults differ by monthly variation in earnings and perceived job insecurity?
- The percentage of workers experiencing serious psychological distress increased as monthly variation in earnings increased (Figure 2).
- Working adults who anticipated losing their job in the next 12 months were more likely to experience serious psychological distress (5.4%) than those who did not anticipate job loss (2.2%).
Figure 2. Percentage of working adults aged 18–64 reporting serious psychological distress in the past 30 days, by variation in earnings and perceived job insecurity: United States, 2021
1Significant linear trend by monthly variation in earnings (p < 0.05).
2Significantly different from at least somewhat likely to lose job in next 12 months (p < 0.05).
NOTES: Serious psychological distress was determined by responses to the six questions comprising the Kessler 6 nonspecific distress scale. Serious psychological distress, defined as a score of 13 or higher on the scale, includes mental health problems severe enough to cause moderate-to-serious impairment in social and occupational functioning and to require treatment. Estimates are based on household interviews of a sample of the U.S. civilian noninstitutionalized population. Access data table for Figure 2.
SOURCE: National Center for Health Statistics, National Health Interview Survey, 2021.
Did differences in serious psychological distress among working adults vary by work schedule characteristics?
- No statistically significant difference in serious psychological distress was observed between adults whose work schedule changed on a regular basis (2.9%) and those whose work schedule did not change (2.6%) (Figure 3).
- Serious psychological distress was higher among working adults who had difficulty changing their work schedule (4.2%) compared with those having a work schedule that was easy or somewhat easy to change (2.2%).
Figure 3. Percentage of working adults aged 18–64 reporting serious psychological distress in the past 30 days, by work schedule characteristics: United States, 2021
1Significantly different from difficult or somewhat difficult to change schedule (p < 0.05).
NOTES: Serious psychological distress was determined by responses to the six questions comprising the Kessler 6 nonspecific distress scale. Serious psychological distress, defined as a score of 13 or higher on the scale, includes mental health problems severe enough to cause moderate-to-serious impairment in social and occupational functioning and to require treatment. Estimates are based on household interviews of a sample of the U.S. civilian noninstitutionalized population. Access data table for Figure 3.
SOURCE: National Center for Health Statistics, National Health Interview Survey, 2021.
Did serious psychological distress among working adults differ by having paid sick leave or working when physically ill in the past 3 months?
- Working adults without paid sick leave (3.9%) were more likely to experience serious psychological distress than those with paid sick leave (2.2%) (Figure 4).
- Serious psychological distress was higher among working adults who worked when they were physically ill in the past 3 months (5.8%) compared with those who did not work when physically ill (1.9%).
Figure 4. Percentage of working adults aged 18–64 reporting serious psychological distress in the past 30 days, by availability of paid sick leave and report of working when physically ill: United States, 2021
1Significantly different from those who had no paid sick leave available (p < 0.05).
2Significantly different from those who worked at least 1 day when physically ill in past 3 months (p < 0.05).
NOTES: Serious psychological distress was determined by responses to the six questions comprising the Kessler 6 nonspecific distress scale. Serious psychological distress, defined as a score of 13 or higher on the scale, includes mental health problems severe enough to cause moderate-to-serious impairment in social and occupational functioning and to require treatment. Estimates are based on household interviews of a sample of the U.S. civilian noninstitutionalized population. Access data table for Figure 4.
SOURCE: National Center for Health Statistics, National Health Interview Survey, 2021.
Summary
In 2021, 2.7% of working adults aged 18 to 64 overall experienced serious psychological distress. Yet rates varied by work conditions: Adults who worked night, evening, or rotating shifts were more likely to experience serious psychological distress than those working a day shift in 2021. Rates of serious psychological distress were also higher among workers who experienced month-to-month changes in their earnings or reported difficulty in changing their work schedule.
Although changes in the labor market and the nature of work in response to the COVID-19 pandemic may have affected work conditions and associations with serious psychological distress, previous research also documented disparities in health outcomes by work shift (2–4) and perceived job insecurity (5,6). This report highlights how uncertainty in work conditions—reflected by shift work, variation in earnings, job insecurity, and inflexible work schedules—is associated with serious psychological distress among working adults aged 18–64. These results suggest the role of work conditions, not just occupation and employment status, as social determinants of health (1,6).
Source: https://www.cdc.gov/nchs/products/databriefs/db467.htm