Women Who Rely on Tips in Service Industry Are More Prone to Depression, Study Finds

Women fill a large percentage of service industry jobs in the United States, and those who rely on unpredictable tips for much of their compensation often face financial instability that could lead to higher rates of mental health issues, new research suggests.

Service workers who count on tips are at greater risk for depression, sleep problems and stress compared with employees who work in nontipped positions, according to a study published in June in the American Journal of Epidemiology.

"The higher prevalence of mental health problems may be linked to the precarious nature of service work, including lower and unpredictable wages, insufficient benefits, and a lack of control over work hours and assigned shifts," lead author Sarah Andrea, a Ph.D. candidate in epidemiology at OHSU-PSU School of Public Health, in Oregon, said in a statement. "On average, tipped workers are nearly twice as likely to live in poverty relative to untipped workers."

In DC, women are ~50% of tipped workers in and almost 75% of tipped workers here are people of color. Both women and people of color in tipped jobs in the District face a poverty rate that is close to FOUR TIMES HIGHER than the rate for the workforce overall. #1FairWage pic.twitter.com/9IyzKDz6qZ

— National Women's Law Center (@nwlc) June 12, 2018

About 102 million Americans work in the service industry, according to the Pew Research Center, filling critical positions in restaurants, salons and transportation. In many cases, these jobs offer base pay at rates up to 71 percent below the federal minimum wage, with the expectation that tips will fill the gap.

The federal minimum cash wage for tipped workers has been frozen at $2.13 per hour for more than two decades, and now represents less than a third of the federal minimum wage of $7.25 per hour.

"Because women represent more than two-thirds of tipped workers nationwide, they, and the families that depend on them, pay the price when the tipped minimum wage falls short," according to the National Women's Law Center.

Service occupations in which workers receive tips often come with an unstable schedule and income, as well as a lack of benefits.

Researchers tested the hypothesis that individuals working in tipped service occupations have greater odds of experiencing poor mental health, relative to individuals in other occupations. To investigate their theory, the researchers looked at population data collected by the government through the National Longitudinal Study of Adolescent to Adult Health, which followed a nationally representative sample of adolescents into adulthood.

The researchers found that the greatest mental health impact was to women, who comprise 56 percent of all service workers and 67 percent of all tipped workers.

Women in the tipped service industries, between 24 and 33, had greater odds of reporting a depression diagnosis or symptoms compared to women in other professions, the researchers reported.

Service industry workers, whether tipped or not, are also are expected to control certain emotions, including anger or disagreement, as well as manage instances of sexualized or hostile behavior during interactions with customers. This emotional suppression might further increase the risk of stress and mental health problems, Andrea said.

"While the idea that 'the customer is always right' may be a valid business plan, our study results indicate that mentality may negatively impact employee health, especially in women," study co-author Janne Boone-Heinonen, Ph.D., an associate professor of epidemiology in the OHSU-PSU School of Public Health, said in a statement.