Survey Finds Many Low-Wage Workers Stressed and Depressed

Abstract

H prevalences of household financial strain, food shortages at home, and work-family spillovers correlate with depression in low-wage nursing home workers, according to a study by researchers at the Harvard School of Public Health. Among 229 primary wage earners in the survey, 40% reported financial strain and 23% reported “food insufficiency.” Of the 187 workers who were not primary wage earners in their families, 20% reported financial strain and 7% reported food insufficiency. More than half (52%) of workers reporting occasional or frequent food shortages at home showed depression on an 11-item version of the Center for Epidemiologic Studies Depression Scale. Depression also showed up in 41% of people facing financial strain. Depression was most significantly linked to financial strain and work-family spillover, preoccupation with work at home, or being distracted at work by personal problems among nonprimary wage earners. The survey covered low-wage earners in four Massachusetts nursing facilities (Am. J. Public Health doi:10.2105/ AJPH.2011.300323). “In working on this study, I was most surprised by the number of people who said they couldn’t provide food for their families,” said lead researcher Dr. Cassandra Okechukwu, an assistant professor at Harvard University. More than 80% of the workers were women. “We really need to look at increasing wages,” said Dr. Okechukwu; it could make a difference in the mental and physical health of both caregivers and facility residents. The authors wrote that other researchers have shown depression to be “associated with absenteeism and turnover among workers, which in turn translates to poorer care for residents in direct care settings.” According to Dr. Okechukwu, “Many nursing home workers also are recent immigrants who may not be aware of or eligible for government aid or benefits. Most of these also are members of a racial or ethnic minority group.” Nursing home managers should make sure that low-wage caregivers are aware of assistance programs they may be eligible for, she said. Some facilities might offer caregivers and their families free meals or access to food pantries. She stressed that leaders at the nursing homes weren’t unsympathetic to the plight of their front-line workers. “Managers generally are empathetic and want to do something, but they don’t know what to do,” she said. “They face the challenge of balancing caring for employees and making sure residents get quality care. One thing we have learned from other workplaces is that it helps if supervisors are more supportive, listen to people’s issues, and are flexible about schedules.” Dr. J. Kenneth Brubaker, CMD, medical director of Pennsylvania-based Messiah Village, said that while a medical director can’t control wages in a facility, he or she can encourage caregivers to move up the career ladder. “Whenever I see nursing assistants doing good work, I make sure... I talk to them about nursing career opportunities, and I encourage them to get more training,” he said. Addressing caregiver stress and depression is a growing priority, Dr. Brubaker said. “Stays in nursing homes are getting shorter,” he said. “People are coming in when their illnesses are more advanced, and caregivers have to deal with the stress of loss.” Also, nursing assistants get very close to residents they care for regularly and experience a tremendous amount of guilt when they die, Dr. Brubaker noted. “We need to acknowledge that this is an issue. We need to give caregivers the opportunity to share feelings, say a prayer together, and find a way to express their grief and honor the residents.... It is important to encourage people to talk to someone if they are depressed or stressed. We need to be attuned to people who might be struggling and let them know that there is help available.” CfA