This study used 2018 and 2022 data from the General Social Survey (GSS) and its Quality of Worklife (QWL) Module to examine and compare self-reported mental health status and working conditions among respondents who were employed either part-time or full-time at the time of the survey. The GSS is a biannual, nationally representative, personal interview survey of U.S. households led by the National Opinion Research Center at the University of Chicago and funded by the National Science Foundation.²³ The QWL module, developed by NIOSH, contains questions on working and mental health conditions, is administered every four years, and was last administered in 2022.^25,26

This study builds upon research originally conducted as part of the first author’s doctoral dissertation, which examined how work-related mental health and well-being are measured among employees in smaller businesses (<50 workers), identified determinants of intervention implementation, and analyzed national trends.³³ This activity was reviewed by CDC, deemed research not involving human subjects, and was conducted consistent with applicable federal law and CDC policy². We followed EQUATER Network reporting guidelines using the STROBE checklist for observational studies (Supplemental Digital Content, http://links.lww.com/JOM/C199).

The subjects were employed U.S. adults who responded to the GSS and were identified according to their response to the number of people working in the respondent’s employment organization at all locations. The sample population included workers employed in businesses composed of between 1 and 49 employees at all locations and who were regular, permanent employees. The subjects were further identified by those who responded to items from the GSS/QWL module in the GSS in years 2018 (11 items, administered via face-to-face interview) and 2022 (17 items, administered via face-to-face interview, telephone or web self-administered questionnaire). In 2018 and 2022, selected respondents included 1263 workers and 953 workers, respectively. Response rates were 59.5% in 2018 and 50.5% in 2022.

Demographic and employment characteristics were selected to understand the composition of workers employed in small businesses (between 1 and 49 employees at all locations) in 2018 and 2022. Fewer than 50 employees were selected as this characterizes how NIOSH typically identifies small businesses.¹⁹ We included employees who reported organization employee numbers of less than 50 employees in our definition of small businesses. This was identified from the GSS variables ‘numorg’ in 2018 and ‘numorg1’ in 2022. We separated contractors from our definition of workers in small businesses and excluded those whose work arrangement was indicated as “on-call.” These characteristics were identified with the ‘wrktype’ GSS variable. During 2018 and 2022, there were 434 contractors (wrktype =1) and 1836 employees identifying any business size (numorg/numorg1 not missing). Of the 1836, there were 513 small businesses (numorg of 1-49). There were 31 people excluded because work type was on-call (wrktype=2) resulting in 482 total small business workers (283 from 2018; 199 from 2022).

Standard demographic characteristics included age, sex, race, education, marital status, and total family income. Age, a continuous variable, was categorized based on U.S. Census groupings²⁶, with some categories collapsed to follow general epidemiologic practice found in the peer-reviewed, published scientific literature.²⁷ The age categories included 18-24; 24-44; 45-64; and equal to or greater than 65. Race of the respondent, a core GSS variable, was categorized as White, Black, and Other in both 2018 and 2022. In 2018, Other was assessed by the interviewer and the categories included American Indian/Alaskan Native, Asian, Native Hawaiian or Other Pacific Islander, or Other.²⁵ In 2022, the respondent had the option to self-identify.²⁷ Education was classified into three categories less than high school, high school diploma or equivalent, and some college-level education. Responses to marital status were converted to separate those currently married and currently not married, where not married included widowed, divorced, separated, or never married. Total family income was categorized into four groups (<35,000, 35,000-74,999, 75,000-149,999, and ≥150,000), following previously published categorization schemes of GSS data.²⁸ Due to small sample size, the two highest categories for income were collapsed into one to include this variable into logistic regression analyses. Child caregiver status was selected as an additional demographic variable as childcare was disrupted during the pandemic²⁹, and had consequential impacts on the employment of working families, especially working mothers of young children.³⁰ Child caregiver status represents the number of children in the household 17 years old and younger and is a composite of three GSS variables: babies (“number of household members under 6 years old”), preteens (number of household members 6 to 12 years old), and teens (number of household member (13 to 17 years).²⁵ Responses were coded as 0, with no household members under 17 years old or 1, with household members between 0 and 17 years old.

Employment characteristics were selected to understand current employment circumstances among workers employed in small businesses.³¹ Variables for employment characteristics included type of work arrangement, hours worked per week in past two weeks, and time at current job. Time in current job collected in the GSS was categorized using the following quartile cut points derived from responses from workers employed in small businesses: less than 1 year; 1-2 years; 3-5 years; and 6 or more years. We estimated the number and proportion of workers in small businesses by each employment characteristic. Type of work arrangement was assessed through response to the question, “How would you describe your employment arrangement in your main job?” We separated the responses into three categories: paid by temporary agency; contractor; and regular, permanent employee. Due to the limited sample sizes found in initial exploratory data analysis, we consolidated the responses of self-employed workers—including independent contractors, independent consultants, and freelance workers—along with on-call workers (those who works only when called) and individuals working for a contractor who provides workers and services to others under contract. These groups were combined and reported collectively under the category “contractor”. Hours worked last week asked, “If working, full-time or part-time: How many hours did you work last week, at all jobs?” Responses were numeric ranging from 0-89. Responses were separated into three categories: 0 hours; between 1-40 hours, and 41 or more hours to reflect respondents’ range of hours. Time at current job was assessed through the response to the question, “How long have you worked in your present job for your current employer?” We separated the numeric responses into four categories: less than 1 year; 1-2 years, 3-5 years; and 6 or more years.

We described self-reported, mental health status using seven items from the GSS/QWL module. For 2018 and 2022, we dichotomized count responses as none (i.e., 0 days reported) or one or more days (i.e., 1-30 days reported) for the following two items: 1) days of poor mental health in past 30 days and 2) days of activity limitation in past 30 days. One single ordinal item measured job stress and asked, “How often do you find your work stressful?” Responses included always, often, sometimes, hardly ever, and never. In 2022, the GSS/QWL module expanded to include additional mental health measures to better capture psychological well-being of the U.S. population,²⁶ especially in light of the COVID-19 pandemic. Mental health-related measures (i.e., anxiety and depression) included four single ordinal variables and asked, “Over the last 2 weeks, how often have you been bothered by the following problems: 1) feeling nervous, anxious or on edge; 2) not being able to stop or controlling worrying; 3) feeling down, depressed, or hopeless; and 4) little interest or pleasure in doing things.” Responses to the ordinal variables included not at all, several days, more than half the days, and nearly every day. The individual problems that were assessed were drawn from a validated composite depression/anxiety screening scale, the Patient Health Questionnaire-4.³²

Perceived working conditions were measured using ten items from the GSS/QWL module. For 2018 and 2022, eight of the ten items assessed working conditions and included job satisfaction; supervisor cares about the welfare of those under them; safety of workers is a high priority for management; trust in management; job demands interfere with family; fair earnings; chances for promotion; and job autonomy. The question for job satisfaction asked, “All in all, how satisfied would you say you are with your job?”, with response options of very satisfied, moderately satisfied, a little satisfied, and very dissatisfied. To measure if their supervisor cares about the welfare of those under them, respondents answered “My supervisor is concerned with the welfare of those under him or her”, with response options of very true, somewhat true, not too true, and not at all true. To assess whether the safety of workers is a high priority for management, respondents responded to the statement “The safety of workers is a high priority with management where I work.”, with response options of strongly agree, agree, disagree, and strongly disagree. To examine trust in management, respondents were asked to respond to the statement, “I trust the management at the place where I work.”, with response options of strongly agree, agree, disagree, and strongly disagree. Work-family conflict was assessed with the question, “How often do the demands of your job interfere with your family life?”, with response options of always, often, sometimes, hardly ever, and never. Chances for promotion was assessed by asking for a response to “Chances for promotion are good.”, with response options of very true, somewhat true, not too true, and not true at all. Fair earnings was measured by asking “How fair is what you earn on your job in comparison to others doing the same type of work you do?”, with response options of much less than you deserve, somewhat less than you deserve, about as much as you deserve, somewhat more than you deserve, and much more than you deserve. Job autonomy was assessed by asking “I am given a lot of freedom to decide how to do my own work.”, with response options of very true, somewhat true, not too true, and not at all true. Two of the ten items assessing working conditions were new items for 2022. The two variables assessed management support for psychological health, asking for a response to “senior management considers psychological health to be as important as productivity”, with response option of strongly disagree, disagree, neither agree nor disagree, agree, and strongly agree, and assessed meaningful work, asking for a response to “I find my work to be very meaningful”, with the response options of strongly agree, agree, disagree, and strongly disagree.

We accounted for the complex survey design of the GSS by including variables for sample weights, sample strata, and primary sampling unit in the analysis using the SAS 9.4 SURVEYLOGISTIC (SAS Institute Inc., Cary, NC, USA) procedure. The study used weighted data from 2018 and 2022 GSS, so that the marginal distributions of the data align with the U.S. working population.^24,25 Unweighted and weighted sample sizes for each analysis were reported.

In 2018, the total number of workers employed in small businesses (1-49 employees at all locations) included in this study was 283. Among the highest percentages of demographics reported for these workers, 52.1% (95% CI: 44.3-59.9) were men; 39.1% (31.2-47.1) were between the ages of 45-64 years; 76.6% (69.2-84.0) were white; 46.1% (38.6-53.6) received some college-level education53.9% (46.0-61.9) were not married; 32.6% (26.3-39.0) received a total family income between 35,000-74,999; and, 72.6% (66.6-78.5) were not caregivers to children ages 0-17 years. For employment characteristics, 92.6% (88.1-97.0) were regular, permanent employees; 60.9% (54.1-67.7) worked between 1-40 hours in the week prior to completing the survey; and 38.6% (32.3-44.8) worked six or more years at their current job.

In 2022, the total number of workers employed in small businesses included in the study was 199. Approximately 51.4% (41.1-61.4) were women; 51.0% (38.9-63.2) were between the ages of 25-44 years; 77.0% (68.1-85.8) were white; 46.6% (36.6-56.7) received some college-level education; 57.6% (44.6-70.5) were married; 31.7% (20.1-43.4) received a total family income between 75,000-149,999; and 62.8% (50.4-75.1) were not caregivers to children ages 0-17 years. For employment characteristics, 95.3% (91.3-99.4) were regular, permanent employees; 63.8% (53.5-74.1) worked between 1-40 hours in the week prior to completing the survey; and 35.5% (23.9-47.1) worked less than one year at their current job. Supplemental Table 1 (http://links.lww.com/JOM/C200) illustrates all the demographic and employment characteristics of workers employed by small businesses for 2018 and 2022. All results were reported using 95% confidence intervals.

Supplemental Table 2 (http://links.lww.com/JOM/C201) presents the descriptive results on mental health status and working conditions in 2018 and 2022. The days missed in the prior 30 days due to mental health that were reported by small businesses workers ranged from 0 to all 30 days. The mean and median for days of poor mental health in past 30 days in 2018 and 2022 is reported in Supplemental Table 2 (http://links.lww.com/JOM/C201).

In 2018, 44.6% [36.6-52.6] of small business workers reported one or more days of poor mental health and 17.9% [11.8-24.0] reported one or more days of activity limitation in past 30 days. In 2022, 54.8% [43.3-66.2] reported one or more days of poor mental health and 29.0% [18.9-39.2] reported one or more days of activity limitation in past 30 days. In 2018, 66.8% of small business workers reported work as stressful (always (2.9% [0.7-5.2]), often (21.7% [15.4-28.0]), and sometimes (42.2% [34.5-49.9])). In 2022, 65.9% of small business workers reported work as stressful (always (9.8% [3.8-15.8]), often (23.7% [13.8-33.6]) and sometimes (32.4% [22.7-42.1])). Among two of four categorical variables on mental health symptoms new for 2022, over 16% of small business workers reported higher levels of feeling nervous, anxious or on edge in the past two weeks (more than half the days, 8.8% [3.1-14.5]; nearly every day, 7.9% [2.1-13.8]) and not being able to stop or control worrying in the past two weeks (more than half days, 10.4% [4.9-16.0]; nearly every day, 5.9% [1.1-10.6]). Over 30% of small business workers reported feeling down, depressed or hopeless in the past two weeks (several days, 23.4% [16.3-30.5]); more than half days, 6.8% (0.3-13.3); and, nearly every day, 2.1% [0.2-4.0] and having little interest or pleasure in doing things (several days, 24.2% [15.3-33.2]; more than half days, 8.2% [2.6-13.8]; and nearly every day, 1.4% [0.0-2.7]).

In 2018, 93.1% of small business workers reported they were either very satisfied (50.3% [42.5-58.1]) or somewhat satisfied (42.8% [34.9-50.8]) with their job. In terms of job autonomy, 95.3% responded very true (64.3% [57.6-71.0] to somewhat true (31% [24.3-37.7]) to question asking I am given a lot of work freedom to decided how to do my own work. When reporting perceptions of management, 92.8% reported that they strongly agree (35.5% [28.3-42.7]) or agree (57.3% [49.4-65.3]) that worker safety health is a management priority; 87.9% reported that their supervisor cares about the welfare of those under him or her (very true, 48.4% [41.2-55.7] and somewhat true, 39.5% [31.7-47.4]); and 89.9% reported they trust the management at the place where they work (strongly agree, 27.7% [21.1-34.3]) and agree, 62.2% [54.2-70.1]). Among small business workers responding in 2018, 37.0% reported that job demands interferes with family life often (10.6% [5.8-15.4]) and sometimes (26.4% [19.3-33.5]). Almost 50% of small business workers reported earning less than they deserve compared to those doing the same work (much less than you deserve, 8.8% [5.0-12.7] and somewhat less they you deserve, 29.5% [21.6-37.5]). In terms of chances for promotion, 56.6% indicated very true (18.1% [11.9-24.2] to somewhat true (38.5% [30.7-46.3] in response to chances for promotion are good.

In 2022, over 90% of small business workers reported they strongly agreed (43.3% [33.8-52.8]) or agreed (48.0% [36.6-59.4]) workplace safety and health is a management priority; moderate to high levels of job satisfaction (somewhat satisfied, 41.3% [30.8-51.8] (very satisfied, 49.3% [40.0-58.6]); meaningful work (strongly agree, 32.1% [22.9-41.1] and agree, 58.7% [47.7-59.7]); and work freedom (very true, 53.0% [41.6-64.4]); somewhat true, 38.3% [25.9-50.7]). In terms of work to family conflict, 35.3% of small business workers reported job demands interfere with family life often (11.9% [5.6-18.2] and sometimes (23.4% [15.4-31.3]). In terms of promotion potential, 25% [14.1-36.0] of small business workers reported that chances for promotion are good were very true and 35.7% [24.7-46.7] responded somewhat true. For fair earnings, 9.7% [4.4-15] of small business workers reported earning much less than they deserve and 39.8% [28.8-50.8] reported somewhat less they deserve. Nearly 23% of small business workers reported that they strongly disagree (10.7% [4.7-16.7]) or disagree (12.1% [5.5-18.7]) that senior management considers psychological health to be as important as productivity, a new GSS/QWL variable for 2022. Among additional perceptions on management, 86.9% of small business workers reported that their supervisor cares about the welfare of those under him or her (very true, 55.7% [44.2-67.2] and 31.2% [18.5-43.9]) and 88.0% reported they trust the management at the place where they work (strongly agree, 34.8% [25.3-44.4]) and agree, 53.2% [43.3-63.2]).

Supplemental Table 3 (http://links.lww.com/JOM/C202) reports odds ratios from logistic regression models assessing the association between low-ranking vs. high-ranking working conditions and the odds of reporting one or more poor mental health days in the past 30 days versus none using combined data from 2018 and 2022. For each unfavorable working condition, the table includes weighted percentages, as well as unadjusted and adjusted odds ratios (aORs) comparing the odds of reporting one or more poor mental health days in the past 30 days versus none. The adjusted odds of reporting one or more poor mental health days in the past 30 days were significantly higher among workers who reported the following unfavorable conditions:

In the unadjusted models, workers who reported their work was not meaningful had significantly higher odds of reporting poor mental health (OR = 3.70; 95% CI: 1.34-10.23) compared to those reporting their work was meaningful. Though this association was no longer significant after adjusting for covariates (aOR = 2.66; 95% CI: 0.84-8.41). Because these data are cross-sectional, causal relationships cannot be inferred.

In a multivariable model including confounding demographic variables and each of these work characteristics was built, as these factors may co-occur for some workers. The magnitude of the effect of each factor was similar to the single factor models, but only not earning a fair wage (OR=2.20, 95% CI: 1.20- 4.02) and work interfering with family (OR = 1.84, 95% CI: 1.01-3.37) remained statistically significant.

This study contributes to a foundational understanding of the burden of mental health and well-being among U.S. workers employed in smaller business. The findings highlight several modifiable working conditions, such as job satisfaction, work-family conflict, and perceptions of fairness and support, that are associated with poorer mental health outcomes. Given the distinct vulnerabilities that may be faced by small business workers, including limited access to occupational health resources and structural supports, these results underscore the importance of developing targeted, scalable interventions. Addressing psychosocial risks in the work environment and organizational capacity may lead to improved mental health and enhanced overall well-being for this predominant segment of the workforce.