People in the middle of their careers, slogging through middle-management, suffer from higher rates of anxiety and depression than people who are at the top or bottom of the social ladder, according to a new study published in Sociology of Health and Illness.

The study, which involved 21,859 full-time employees, found that 18 percent of supervisors and managers reported suffering from anxiety or depression, while only 12 percent of workers could say the same. The study sheds light on the way that those in middle-management positions deal with their position of power and socio-economic class, and how these internalizations develop into symptoms of depression.

“We explored how social class might influence depression and anxiety in ways that may be masked or incompletely explained by standard socioeconomic status measures,” said Seth J. Prins, a co-author of the study and doctoral student in epidemiology at Columbia University’s Mailman School of Public Health, in a statement.

The researchers estimated the prevalence and odds of lifetime and previous 12-month depression and anxiety by looking at income, education, and occupational class categories. The class categories included: owners, those who were self-employed and earned greater than $71,500; managers and supervisors, who occupied executive or managerial roles; and workers, who were common laborers.

Many managers are given positions of power but have to deal with the day-to-day problems that arise in office environments full of workers, who they must develop mutual trust with. At the same time, they are also members of a different social and economic class, in which they must develop relationships with the owners as well. Considering many may also be trying to continue to climb the social ladder, all of these factors combine into a stress that pulls the manager in different directions, causing devastating mental health effects. For many of these managers, the researchers found, symptoms of depression didn’t arise until after they entered the workforce, and began dealing with these issues.

“Our findings highlight the need for population health research to both conceptualize and measure social class in ways that go beyond the standard measures of socioeconomic status,” said Dr. Lisa Bates, co-author of the study and assistant professor of Epidemiology, in the statement. “Standard measures are most readily available, but can mask important complexity in the relationship between social class and population health.”

Source: Prins S, Bates L, Keyes K, et al. Anxious? Depressed? You might be suffering from capitalism. Contradictory class locations and the prevalence of depression and anxiety in the USA. Sociology of Health and Illness. 2015.