Abstract
BACKGROUND: There are growing global concerns about informal waste pickers and their health issues. This cross-sectional study drew on the structural violence theory to examine the mental health situation of informal waste pickers in Hong Kong and identified the determinants of depression and anxiety in them ranging from individual to societal and governmental levels. METHOD: The data from the largest territory-wide study of informal waste pickers in 2023 was analysed. Descriptive statistics and logistic regressions were used to investigate the association between mental health and socioeconomic variables, including demographic background, governmental measures against informal waste pickers, other negative experiences related to safety and public discrimination, and supportive resources. The symptoms of depression and anxiety were assessed using the Patient Health Questionnaire (PHQ) and General Anxiety Disorder (GAD). RESULTS: The results showed that physical strain/illness and chronic illness caused by long-term scavenging works (for depression adjusted OR 3.33, 95% CI [1.75, 6.31]; for anxiety adjusted OR 5.01, 95% CI [2.45, 10.24]), recycling or personal property stolen (for depression adjusted OR 2.04, 95% CI [1.23, 3.36]; for anxiety adjusted OR 2.72, 95% CI [1.62, 4.56]), being treated rudely by citizens (for depression adjusted OR 2.16, 95% CI [1.32, 3.55]); for anxiety (adjusted OR 2.85, 95% CI [1.74, 4.67]) are the critical risk factors of informal waste pickers' mental health. While higher intention to continue scavenging work if financial conditions permit is the critical protective factor for depression (adjusted OR 0.46, 95% CI [0.24, 0.88]) and anxiety (adjusted OR 0.43, 95% CI [0.22, 0.86]), compared to lower intention to continue scavenging work if financial conditions permit in the multivariate model. CONCLUSIONS: This study discloses the close relationship between informal waste pickers' long-term physical strain/illness and mental health and identifies the governmental measures, other negative experiences related to safety issues and public discrimination as risk factors for informal waste pickers' mental health. Providing outreach, tailored medical services, increasing the unit price of recycling, developing specific recycling zones and establishing membership-based organisations help alleviate the challenges of precarious employment and enhance the well-being of the informal waste pickers.