OBJECTIVES: “Diseases of despair”, or diagnoses related to suicidal ideation/behavior, or alcohol/drug use, have been rising rapidly the past two decades. However, few studies have evaluated this trend by employment setting, and no analysis has extended past 2015. This study aimed to evaluate the relationship between diseases of despair and industry and occupational settings utilizing Medical Expenditure Panel Survey (MEPS) data from 2016-2020.

METHODS: MEPS survey participants were included if they were 16-64 years old and reported current employment with a valid industry code in at least one of the three annual interview rounds. Diseases of despair were identified using previously reported ICD-10-CM codes and CCSR categories. Industry categories were adapted from the North American Industry Classification System. Additionally, MEPS occupational categories were grouped into “white-collar”, “blue-collar” and service occupations. Descriptive statistics and multiple logistic regressions were estimated to examine the influence of these employment characteristics and having a disease of despair recorded controlling for demographic and socioeconomic factors, region of residence, survey year, insurance coverage, smoking status, comorbidities, self-reported physical health status and level of pain interference.

RESULTS: A total of 65,617 working age adults (weighted 159,694,771 per year) were included in the analysis. Among the weighted sample, 1,661,635 (1.05%) were estimated to have ≥1 disease of despair. Compared to those employed in the professional/business services industry, manufacturing industry employees were significantly less likely to have a disease of despair diagnosis (AOR: 0.466; p=0.016). No other industry settings were significantly different. No significant differences were observed between blue collar and service occupations compared to white collar occupations.

CONCLUSIONS: Contrary to prior research, those employed in the manufacturing setting were less likely to have a disease of despair compared to those in the professional/business services industry employees. No other industry or occupational contrasts were significantly associated with diseases of despair.