In the hierarchy of the workplace, it is those in the middle, not necessarily the bottom, particularly supervisors, who show the highest levels of anxiety and, to a lesser degree, depression, new research suggests.
"The key message for clinicians is to appreciate that social context, or what epidemiologists call the social determinants of health, matters," said lead author Seth Prins, MPH, a predoctoral fellow in the Department of Epidemiology at Columbia University's Mailman School of Public Health, in New York City.
"Obviously, a mental health professional can't prescribe a job promotion, but ignoring the socioeconomic context of their patients, or treating such factors as individual characteristics, probably isn't the best idea either," he told Medscape Medical News.
The findings were published online August 3 in the journal Sociology of Health and Illness.
Middle Ranks
Research has shown an increased risk for mental and physical illness among those in lower socioeconomic classes and in the lower ranks of the workplace. However, some evidence suggests a higher risk of internalizing disorders, such as depression and anxiety, in middle social ranks, where employees can face unique pressures with regard to job responsibilities and control, compared with lower or higher ranks.
To better evaluate the theory, the researchers evaluated data on 21,859 fulltime workers who were respondents in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative survey of the US population aged 18 years and older who were interviewed in person.
They identified respondents in three categories: business owners identified as self-employed and earning more than $71,500; managers and supervisors who held executive, administrative, or managerial positions; and workers of various occupations, including farmers and laborers.
They found that in estimates of lifetime and 12-month depression and anxiety, workers in positions in the middle socioeconomic classes, particularly supervisors, had significantly higher levels of anxiety compared with workers in lower and higher classes. Rates of depression were less consistent.
For example, the prevalence of all disorders was higher among supervisors than among lower-ranking workers, with higher odds of lifetime depression (odds ratio [OR], 1.75; 95% confidence interval [CI], 1.58 - 1.93), lifetime anxiety (OR, 2.33; CI, 1.97 - 2.75), 12-month depression (OR, 1.19; CI, 1.03 - 1.37), and 12-month anxiety (OR, 1.76; CI, 1.39 - 2.23).
Managers had the next highest levels in terms of all disorders. Compared with lower-ranking workers, they had higher odds of lifetime depression (OR, 1.2; CI, 1.06 - 1.35) and lifetime anxiety (OR, 1.36; CI, 1.19 - 1.57).
Compared with those above them ― business owners in the private sector ― supervisors had the highest odds of lifetime depression (OR, 1.86; CI, 1.5 - 2.31) and 12-month depression (OR, 1.4; CI, 0.9 - 2.16), and they had much higher odds of lifetime anxiety (OR, 5.13; CI, 3.1- 8.6) and 12-month anxiety (OR, 9.39; CI, 7.76 - 11.35).
The results underscore the unique pressures of middle management positions, which can involve higher levels of stress than lower-ranking positions, Prins explained.
"We suspect the [stress contributor] is this dual role of middle management — being expected to enforce policies in which they have little say, but also facing antagonism of subordinates," he explained.
"In other words, middle managers have to take flak from the top down as well as from the bottom up," he said.
Whereas lower-ranking workers may be able to attribute conditions causing stress to external factors that are out of their control, supervisors may be more prone to internalizing stressful work conditions and attributing them to personal failure, Prins added.
"Research has consistently shown that external attributions are protective against low self-esteem and internalizing disorders such as depression," he said.
"Along these lines, there may be more solidarity and social support among frontline workers than among the managerial class. These are questions that we hope to explore in future research."
As in many stressful situations, people in middle management positions who experience anxiety may exacerbate the problem with self-neglect, said Andrew O. Brown, MD, lead psychiatrist with the Boston Police Department and president of the Academy of Organizational and Occupational Psychiatry.
"If someone is worried about losing their job and is in a pressure-cooker type of situation, they really have to devote more attention rather than less to basic self-care and issues such as physical exercise," he told Medscape Medical News.
Dr Brown underscored the need for people in such situations to seek help from capable mental health professionals.
"It's important to work with a therapist who is capable of understanding how the patient's personal history applies to the stressful experience at work and who can take an active role in helping with decision making and constructive advice," he said.
Employers can also take an active role in addressing workplace stress at any level with programs offered through the American Psychiatry Association Foundation's Partnership for Workplace Mental Health.
The partnership works to provide employers with programs to raise awareness about mental health issues in the workplace and encourage a supportive culture in which workers can feel comfortable in reaching out for help if needed.
The study was supported by the National Institute of Mental Health. Seth Prins and Dr Brown have disclosed no relevant financial relationships.
Sociol Health Illn. Published online August 3, 2015. Abstract
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Cite this: Anxiety Levels Highest at Mid Management in Workplace - Medscape - Aug 28, 2015.
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