Anxiety, depression, and other mental health issues plague Americans across socioeconomic lines, but those in the lowest rungs of the socioeconomic ladder are most likely to suffer depression and anxiety. Now research from Seth J. Prins, Lisa M. Bates, Katherine M. Keyes, and Carles Muntaner finds that those stuck in the middle—not only the middle class—are at the most risk.

Usually sociologists use household income and education level provide sufficient measures for socioeconomic status, but the authors assert that these metrics miss crucial information about mental health when used alone. Using a nationally representative survey, the researchers investigate the relationship between depression and anxiety with additional socioeconomic indicators including income, education, and the presence of what these authors call “contradictory class location.”

As opposed to the business owner or the person who does the manual work for the company, someone with a contradictory class location falls in the middle, usually as a supervisor or manager. They have authority over other workers, but still answer to the big cats upstairs—positions that can feel contradictory.

Contradictory class location, the authors write, helps explain why depression and anxiety affect the middle-class in a specific way. In part, the increased risk may come from competing stressors: the feeling of being dominated by superiors and the responsibility of managing others. People in these supervisor and manager positions are more likely to blame themselves for issues in the company, whereas those in non-contradictory class locations tend to look toward external factors.