STASH, Vol. 17(7) – Kitchen confidential: Mental health and substance use among restaurant workers in the wake of COVID-19

The COVID-19 pandemic has hit the restaurant industry hard. Early on, restaurants had to limit services to take-out and delivery only, which resulted in substantial losses in sales and jobs. Even now with the lifting of restrictions in the United States, most people are still unwilling to dine at restaurants, forcing many to close permanently. Due to the fast-paced and stressful work environment, restaurant employees experience high levels of mental health issues, especially with added worries about exposure to the COVID-19 virus. The restaurant industry is also ranked highly for illicit drug use and heavy alcohol consumption. Considering the rise in unemployment as well as concerns regarding restaurant workers’ mental health and substance use, it is important to understand how restaurant employees are faring during the pandemic. This week, STASH reviews a study by Diego Bufquin and colleagues that investigated the relationships between restaurant employees’ work status, mental health, substance use, and career turnover intention during the COVID-19 pandemic.

What was the research question?
What are the relationships between restaurant employees’ work status, mental health, substance use, and career turnover intention during the COVID-19 pandemic?

What did the researchers do?
In June 2020, the researchers distributed an online questionnaire to non-managerial adult restaurant workers who were currently working, furloughed, or laid-off during the COVID-19 pandemic. (Furloughed employees are on temporary leave, usually because of insufficient work; laid off employees have been terminated, usually because of long-term downsizing.) A total of 585 eligible respondents completed the questionnaire. Participants reported their current work status (working, furloughed, or laid-off) and completed an 18-item Mental Health Inventory, an adapted Obsessive Compulsive Drug Use Scale, the Short Michigan Alcoholism Screening Test, and job satisfaction and commitment questions to evaluate the following measures, respectively: psychological well-being/psychological distress, drug use thoughts and cravings, drinking consequences, and career turnover intention.

The researchers used a two-step approach to analyze the data. First, they tested the validity of each measure by confirmatory factor analysis. Then, they used structural equation modelling to examine the relationships among measures. In this model, they compared how still working employees and laid off employees differed from furloughed employees.

What did they find?
Compared to furloughed employees, working employees reported higher levels of psychological distress, stronger drug use thoughts/cravings, and more severe drinking consequences. Furloughed and laid-off employees were similar in regards to mental health, substance use, and career turnover intention.

In turn, psychological distress increased drug use thoughts/cravings, drinking consequences, and wanting to find a new job in a different industry. Interestingly, psychological well-being had the same influence — it was associated with more drug use thoughts/cravings, drinking consequences, and career turnover intention. The results additionally indicated that drinking consequences, but not drug use thoughts and cravings, decreased employees’ desires to change careers.

Figure. The relationships between employment status, mental health, substance use, and career turnover intention among restaurant workers. Bolded arrows indicate a statistically significant relationship. Plus signs (+) indicate a positive association. Minus signs (-) indicate a negative association. Laid-off employees were no different from furloughed employees on any of the measured outcomes. Adapted from Bufquin et al., 2021. Click image to enlarge.

Why do these findings matter?
Work status appears to impact employees differently during the pandemic. Previous studies had associated unemployment with high psychological distress and substance use, but the possibility of catching COVID-19 and a substantial reduction in tips have led to more stressful circumstances for working employees now. Those who were furloughed seemed to have some protection from these stressors. Restaurants need to implement strategies that consider the stressors placed on employees and prioritize their health, especially as restaurants reopen and increase service capacity. The researchers suggest that restaurant owners partially furlough employees and stagger shifts so all employees have both working shifts and furloughed days, which may help reduce employee stress by shortening the work week, allowing access to some unemployment benefits, and providing time for recovery between shifts. Employees should also be informed about available resources for mental health and substance use issues, as well as coached on healthy ways to cope with stress, like taking care of physical and mental health, connecting with others, and taking time to unwind.

Every study has limitations. What are the limitations in this study?
The researchers did not measure illicit drug and alcohol use, but rather drug use thoughts/cravings and drinking consequences, so the results do not reflect how substance use itself is related to work status, mental health, and career turnover intention. Because the data was collected using convenience sampling, there may be sampling bias and a lack of representativeness. The study is also based on self-reports, which could bias the results too. In addition, the survey was only given to restaurant workers in the United States, so the results may not be generalizable across countries or other sectors of the hospitality industry. More research is needed to learn how the COVID-19 pandemic is impacting psychological and behavioral outcomes of restaurant employees and hospitality workers around the world.

For more information:
The Burnt Chef Project is a UK-based non-profit that aims to eradicate mental health stigma within the hospitality industry worldwide. They have conducted two surveys with hospitality workers to learn about their mental health needs and feelings on returning to work post-pandemic. They also offer 24/7 Text Support Service and other free resources for anyone involved in hospitality.

Health professionals and addiction specialists have been increasingly focused on mental health as it pertains to COVID-19. They have assembled substance use resources specific to COVID-19-related concerns, which can be found on the National Institute on Drug Abuse and Centers for Disease Control and Prevention websites.

If you are worried that you or someone you know is experiencing addiction, the SAMHSA National Helpline is a free treatment and information service available 24/7. For more details about addiction, visit our Addiction Resources page.

— Caitlyn Fong, MPH

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