Discussion
This study examined the association between sleep deprivation and psychological stress among ORHDs, considering a wide range of work-related and socioeconomic factors. We found that ORHDs with debt and more severe family-work conflict are more likely to suffer from psychological stress due to sleep deprivation. These findings are in line with previous works in China, Iran and Brazil,16–18 strengthening the argument that sleep deprivation is a significant risk factor for mental health among ORHDs worldwide.
Age is strongly associated with the psychological distress experienced by ORHDs. While limited research has been conducted among ORHDs, age is commonly linked to behavioural intention and driving behaviour, with older drivers being more likely to have lower intentions and frequencies of unsafe driving behaviours.5 Younger ORHDs often work longer hours and take fewer breaks compared with older ORHDs.19 This observation may partially explain the findings of this study that older drivers may suffer less from the associations with sleep deprivation on psychological stress due to safer driving behaviours and shorter working schedules in terms of distance and time spent driving.
This study discovered that longer lengths of service may increase the risk of psychological distress among ORHDs. Another study conducted in China found that older drivers and those with more experience and activity are more susceptible to the effects of the increasingly competitive working environment, resulting in income reduction.20
A strong relationship between financial difficulties and adverse mental health outcomes has been extensively reported in the literature.21 Professional drivers are believed to face elevated stress levels and a heightened likelihood of encountering financial challenges.22 This research also found strong associations between debt, sleep deprivation and psychological distress. Despite the combined effect correlation of debt on the sleep deprivation-psychological distress association that exacerbates the association between sleep deprivation and psychological stress (online supplemental figure 2), the effect role of debt is complicated in this case. Its primary effect may mitigate the impact of sleep deprivation on psychological stress, while its interaction effect with family-work conflict and sleep deprivation could amplify the effect of sleep deprivation on psychological stress (table 1).
Our study has several strengths, including a representative sample and comprehensive consideration of many socioeconomic factors compared with previous literature. With a robust design and multiple dimensions of the data, we uncovered correlations between several work-related factors and mental health outcomes, which provide a fresh perspective for the rapidly expanding ORHD industry.
This study has some limitations. First, the nature of the cross-sectional study limited our ability to make causal inferences about our results. Prior studies also noted that sleep deprivation and debt may have a long-term and interactive correlation.18 23 24 Therefore, our study may not fully elucidate the dynamic correlations between debt, sleep deprivation and mental health outcomes. Second, our sample size is relatively small for such a large occupation population in China. According to the latest report, there were 5.09 million ORHDs by the end of 2022.2 25 Our study is also limited by the non-random sampling method, so our findings based on a comparatively small sample, though from three major cities, may not be generalisable to other regions in China and other countries. Third, the associations between debt, sleep deprivation and psychological distress may require extra caution in interpretation due to the diverse socioeconomic statuses of the participants and varying living expenses across the three cities where our study was conducted. The inconsistency compared with previous studies could also result from insufficient information on potential confounders, such as the specific amount of debt, shift work status, family income and marital status, which were not covered in the questionnaire. Fourth, assessments relied on self-report scales and questionnaires, which may introduce measurement bias. Finally, as our findings are based on a sample from China, their generalisability to other countries may be limited due to differences in working circumstances and regional legislation.
Our findings hold significant implications for the well-being of ORHD and the general public. The association between insufficient sleep and safety hazards is a critical concern, as sleep-deprived drivers are at an increased risk of accidents due to impaired attention and slower reaction times. The insidious nature of sleep deprivation as a potential catalyst for psychological distress underscores the need to recognise it as a crucial public mental health concern. Furthermore, the escalating psychological burden experienced by drivers could potentially impair their quality of life and well-being. The elevated stress levels may further precipitate a ripple impact, negatively influencing their capacity to provide reliable ride-hailing services, and even compromising the safety of passengers. Given the large and growing population of ORHDs and their users, this could pose a potentially significant public health issue. Addressing these multifaceted challenges demands a comprehensive approach. Strategies such as enhancing income by reducing platform commissions can alleviate financial strain and thereby reduce stress levels among drivers. The platform and the relevant authorities should also enforce stricter restrictions on working overtime to prevent fatigue driving. Moreover, the introduction of national policies to safeguard the rights and interests of ORHDs could mitigate their financial vulnerabilities and ensure fair treatment within the broader framework of labour rights. Future research should focus on distinguishing the role of socioeconomic status (eg, debt status and family-work conflicts) from causal effects through longitudinal studies with larger samples.
