Perfil ocupacional e transtornos mentais comuns entre trabalhadores moradores de favelas, Salvador/BA, 2023- 2025.

Abstract

Introduction: Informal settlements, also known as communities or favelas are territories historically occupied in an attempt to secure the right to housing within urban centers for workers living in situations of socioeconomic vulnerability. It is the residents of these communities who cross large cities to take on precarious jobs in the struggle for survival. Over the past decade, changes have taken place that have increased vulnerability in the Brazilian labor market, such as the Labor Reform, the Outsourcing Law, the rise of the platform economy, and the economic crisis caused by COVID-19. Extensive evidence demonstrates that labor informality and employment precarity constitute significant risk factors for adverse health outcomes, particularly common mental disorders (CMDs). Despite their visible presence in urban landscapes, the occupational characteristics and mental health burden among workers of these communities remain critically understudied in the academic literature. Objective: To characterize the sociodemographic and occupational profile and estimate the prevalence of common mental disorders (CMDs) and associated determinants among informal settlement-dwelling workers in Salvador, Bahia State, Brazil (2023–2025). Methods: We conducted a cross-sectional epidemiological study nested within the Urban Leptospirosis Prevention Sanitary Interventions cohort. Structured interviews were administered to workers aged 18–70 years across five informal urban settlements (favelas) in Salvador, Bahia State, Brazil (2023–2025). Data were collected using previously validated structured questionnaires. The outcome was assessed using the Self-Reporting Questionnaire (SRQ-20), with a cutoff of ≥8 positive responses for women and ≥6 for men. Data were collected through household visits using mobile phones and the REDCap platform. The theoretical framework incorporated sociodemographic and occupational independent variables. Data analysis was conducted in R/RStudio (v3.6.0+), with absolute and relative frequency measures for all variables. Chi-square and Fisher’s exact tests were used to evaluate group heterogeneity. Poisson regression (reporting prevalence ratios [PR] with 95% confidence intervals [95% CI]) to identify outcome-associated determinants. Multivariate model selection followed dual criteria: theoretical relevance and statistical threshold (p≤0.10). Final analyses included stratification by employment type, with detailed tabulation of informal workers’ sociodemographic-labor profiles and common mental disorder (CMD) prevalence. The study was approved by the Ethics Committee from the Institute of Collective Health on November 21, 2023, under CAAE 75382123.0.0000.5030 and Opinion Number 6.515.557. All participants signed an informed consent form (TCLE). Results: The study surveyed 587 workers, with 50.9% identifying as female and 29% aged between 40 and 49 years. Strikingly, 97% of participants self-identified as Black (encompassing both preta [Black] and parda [Brown/Mixed] racial categories under Brazil’s classification system). Regarding occupational characteristics, formal workers constituted 56.5% of the sample compared to 41.2% engaged in informal employment. The most prevalent employment arrangement was the CLT regime (Brazil’s consolidated labor laws for formal contracts; 40.7%), followed by informal self-employment (26.3%). The commerce/services/food sector employed the largest proportion of workers (26%). Overall prevalence of common mental disorders (CMDs) stood at 14.0%, with significantly higher rates among informal workers (22.7%). Adjusted analysis revealed three critical findings: First, the informal employment status showed a strong positive association (PR=2.31; 95%CI:1.12-4.83), indicating more than double the risk compared to formal workers. Second, persistent job insecurity ("always/almost always" fearing job loss) had also a positive association with the outcome (PR=2.32; 95%CI:1.05-4.70). Conversely, workers aged 40-49 years demonstrated a negative association with CMDs compared with the younger group (PR=0.43; 95%CI:0.19-0.93). Among informal workers, younger age groups, primary childcare responsibility, monthly earnings below R$1,000 (≈US$200 PPP), and shorter job tenure (≤3 years in the current position) all showed a trend toward higher prevalence. Conclusion: The study revealed a 14% overall prevalence of common mental disorders (CMDs) among slum-dwelling workers. Our research identified two positive associations with increased mental health burden: informal employment status and persistent fear of job loss, both significantly associated. Conversely, workers aged 40-49 years demonstrated a protective effect against CMDs. These results provide crucial epidemiological evidence for an often invisible workforce in occupational health research - informal workers in precarious urban settlements. The data underscore an urgent need for public policies addressing: (1) labor conditions in informal sectors, (2) socioeconomic vulnerabilities, and (3) targeted mental health interventions for marginalized urban communities. Keywords: Cross-Sctional Studies, Slum, Occupational Groups, Occupational Health, Mental Disorders