Female hospitality workers who rely on tips in addition to base pay are more likely to report symptoms of depression compared with those who work in non-tipped positions, according to a study published in the American Journal of Epidemiology.

The analysis is based on data from a nationwide health study that tracked thousands of individuals from adolescence into adulthood.

“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,” said lead author Sarah Andrea, M.P.H., a Ph.D. candidate in epidemiology at the Oregon Health and Science University School of Public Health (OHSU-PSU).

“On average, tipped workers are nearly twice as likely to live in poverty relative to untipped workers.”

Around 102 million people work in the service, or hospitality, industry in the United States, filling important positions in restaurants, hotels, salons and transportation, according to the Pew Research Center.

Many of these positions offer base pay at rates up to 71 percent lower than federal minimum wage, with the expectation that tips — which are highly unpredictable — will make up the difference.

In addition, both tipped and untipped employees working in service jobs are expected to control certain emotions, including anger or disagreement, as well as manage instances of sexualized or hostile behavior during interactions with customers.

According to Andrea, these factors may further exacerbate the risk of stress and mental health problems across the service industry, with the greatest impact to women, who comprise 56 percent of all service workers and 67 percent of all tipped workers.

“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,” said study co-author Janne Boone-Heinonen, Ph.D., M.P.H., an associate professor of epidemiology in the OHSU-PSU School of Public Health.

The research team suggests that additional research be conducted to better understand the factors that contributed to differences in mental health impact amongst this segment of workers.

Depressive illnesses affect more than 19 million American adults each year. One in 8 women are expected to develop clinical depression at some point in their lifetime, with the condition being most common among women aged 25 to 44, according to Mental Health America. Symptoms may include feelings of hopelessness, fatigue, irritability and loss of pleasure in formerly enjoyable activities.

Source: Oregon Health & Science University