“Professional waitress” by Shih-Chi Chiang is licensed under CC BY 2.0

Women in Tipping Professions Susceptible to Depression

MedicalResearch.com Interview with:
“Professional waitress” by Shih-Chi Chiang is licensed under CC BY 2.0Sarah Andrea, MPH
School of Public Health

MedicalResearch.com: What is the background for this study?

Response: We spend one-third of our adult lives at work, and our work-related experiences and exposures affect our health. 14 million people work in the leisure and hospitality industry, a subset of the service industry that includes food service and personal care workers. This industry is simultaneously one of the fastest growing and lowest paid. In addition, work in this industry is frequently characterized by lack of control over hours and shifts worked, as well as insufficient access to health care and other benefits.

Studies have previously found the highest burden of depression and sleep problems for workers in this industry compared to others.

Individuals working in the service industry who earn the bulk for their income from tips from customers face additional vulnerabilities. In many states, tipped workers are paid as little as $2.13 an hour and rely on customers to make up the difference in tips, which are inequitable and unpredictable. Prior to this study, the potential health implications of tipped work were minimally assessed.

MedicalResearch.com: What are the main findings?

Response: We observed the highest burden of depression among women in tipped service occupations and the lowest burden among similar women in non-service occupations. We did not observe this in men. Reasons for these gender differences can only be speculated at this time. We observed that a greater proportion of men in tipped occupations had access to health benefits and that they made more per hour than women on average.

Notably, based on other research, women do make up 67% of the tipped work force, are at high risk for sexual harassment, and are tipped less than men on average. 

MedicalResearch.com: What should readers take away from your report?

Response: Our findings suggest that one or more aspect of tipped service may place women at increased risk of mental health problems, like depression. Importantly, upwards of 5 million women work in tipped service occupations in the United States.

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: More research is needed to better understand why women in tipped service occupations may be more susceptible to poor mental health so that appropriate interventions can be identified. To that end, we are currently investigating the role of the tipped worker subminimum wage as a modifiable target for improving the health of women. 


Sarah B Andrea, Lynne C Messer, Miguel Marino, Janne Boone-Heinonen.Associations of Tipped and Untipped Service Work with Poor Mental Health in a Nationally Representative Cohort of Adolescents Followed into Adulthood.American Journal of Epidemiology, 2018; DOI: 10.1093/aje/kwy123

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Last Updated on August 2, 2018 by Marie Benz MD FAAD