One in Three Macau Casino Workers Report Severe Anxiety, Study Finds

A peer-reviewed survey of 563 employees at six of Macau's integrated resort operators found 33.9% in the severe or extremely severe anxiety band and 16% reporting depression at the same level. The strongest protective factor the researchers identified costs an operator nothing: colleagues who talk to each other.

• The study surveyed 563 full-time employees across six major integrated resort companies in Macau and found 33.9% reporting severe or extremely severe anxiety
• A further 16% reported severe to extremely severe depression, in a workforce the authors describe as carrying high emotional labour and irregular schedules
• Venting to peers was found to reduce burnout and improve emotional health, while maladaptive coping strategies intensified distress
• Employees with lower educational attainment relied more on interpersonal venting and on online gambling as coping behaviours
• The paper is published open access in BMC Psychology by researchers at the University of Saint Joseph in Macau, and received no external funding

The Survey Went to the Operators' Own Managerial Divisions

A study of psychological health among casino employees in Macau has found roughly one in three respondents reporting anxiety in the severe or extremely severe range, a rate the authors attribute to the emotional labour and irregular scheduling that characterise integrated resort work.

The paper, Stress coping strategies as predictors of job fatigue and psychological health among casino employees in Macao SAR (China), was published in BMC Psychology on 11 August after being accepted on 23 July. Its authors are Tang Su, Jacky Ho, Mohammad Anisur Rahaman and Botelho FP, working principally from the Faculty of Health Sciences at the University of Saint Joseph in Macau. The version currently posted is an early accepted manuscript, published ahead of the final version of record.

Data were collected in 2023 through electronic surveys distributed to the managerial divisions of six major integrated resort enterprises, yielding 563 valid responses. Analysing them with ANOVA and regression, the researchers found moderate to high burnout across the sample, with 16% of respondents reporting severe to extremely severe depression and 33.9% severe to extremely severe anxiety.

The coping findings are the paper's substantive contribution. Venting to peers functioned as a protective factor, reducing burnout and improving emotional health, while maladaptive strategies intensified distress. Coping behaviour varied by demographic group. Employees with lower educational attainment showed greater reliance both on interpersonal venting and on online gambling, and those earning between MOP 25,000 and MOP 30,000 a month, approximately $3,100 to $3,700, most frequently used venting as a stress-relief strategy.

Asia Gaming Brief, reporting the study, said the researchers used the 21-item Depression Anxiety Stress Scale and surveyed employees between October and December 2023. It reported a further 18.7% of respondents in the moderate anxiety band, taking the proportion experiencing moderate to extremely severe symptoms to 52.6%, and put severe stress at 4.1% with another 0.6% classified as extremely severe. It also reported that 63.9% of respondents turned to friends or colleagues for emotional support and 55.9% to family members, and that the authors recommended operators strengthen employee assistance programmes, confidential counselling and peer-support arrangements, alongside more balanced shift rotations, designated breaks and fatigue risk management systems.

The study received no external funding and its authors declare no competing interests. Ethical approval came from the University of Saint Joseph, and participation was voluntary and anonymous.

A 2023 Survey Landing in 2026 Is Still the Best Data the Sector Has

The fieldwork predates the current earnings cycle by three years, and Macau's operating environment has changed since: visitation has recovered against a cautious September forecast, promotional spending has hit records, and non-gaming obligations under the current concessions have reshaped what a resort employee does. None of that makes the numbers stale in the way a revenue figure would be. Occupational mental health moves slowly, and there is no comparable published baseline for this workforce. Operators who want to argue the picture has improved will have to produce their own data, which is exactly the position the paper puts them in.

The Protective Factor Points Away From Programmes and Towards Rosters

The finding that peer support reduces burnout is not a recommendation to buy anything. It says that employees who have colleagues they can talk to fare better, which is a function of team stability, shift patterns and whether the working day contains any point at which two people can speak. The authors frame emotional health in high-demand service industries as a systemic outcome shaped by organisational structure, work schedules and cultural norms, and the practical recommendations Asia Gaming Brief reports follow from that: rotation design, designated breaks, fatigue risk management. Those are scheduling decisions made by operations, not wellbeing decisions made by human resources, and they are considerably harder to implement than a counselling helpline.

Online Gambling as a Coping Behaviour Is the Line the Industry Should Read Twice

Among the coping strategies the study measured, online gambling appears alongside venting as something lower-educated employees reach for more often, and gambling-related coping was associated with poorer psychological health. Macau prohibits residents from certain forms of local play and casino staff face their own entry restrictions, which makes the online channel the available one. An industry that has spent two years building self-exclusion and player-protection machinery for its customers has a harder question to answer about the people serving them. The dataset here is small and self-reported, and it deserves a larger study rather than a press release.

The headline number will travel. The more useful finding is that the cheapest intervention available to a Macau operator is a roster that lets staff talk to one another, and nobody has yet published evidence that they do.