This dissertation examines the relationship between depressive symptoms (DS) and paid domestic workers (PDWs) in Mexico. Its main goal is dual. First, it aims to stimulate further research on common mental disorders and the social determinants of mental health of PDWs, particularly in countries with large proportions of non-migrant workforce in paid domestic work. Second, it seeks to address the research gap on DS among Mexican PDWs. To achieve these aims, the research was conducted in two sequential components.

First, following the Joanna Briggs Institute guidelines for mixed-methods systematic reviews, a protocol was developed to review the evidence on the relationship between being a non-migrant paid domestic worker and experiencing DS. This review allowed for describing the quantity and assessing the quality of studies that analyze this relationship.

Second, a statistical analysis was conducted with data from a national health survey (ENSANUT). A sample of 20,893 Mexican workers was selected and segmented into six workforce groups, including PDWs. The analysis design incorporated findings from the review, particularly for the operationalization of three sets of variables associated with DS (sociodemographic, socioeconomic, and work and employment conditions). The health outcome variable was defined as DS of clinical significance measured with a 7-item abridged version of the Center for Epidemiologic Studies Depression Scale (CESD-7) included in ENSANUT. The analysis was performed in three steps: (1) crosstabulation of variables across the sample with inferential statistics; (2) multiple logistic regression modeling of DS; and (3) postestimation of DS prevalence.

The systematic review suggested that PDWs experience DS more frequently than other workers in precarious jobs, signaling a social gradient of mental health among informal workers. Reported DS prevalence among PDWs in the selected studies ranged from 28% (95%CI=22–35) to 53% (95%CI=46–60). Qualitative evidence identified structural conditions, such as poverty and intersectional discrimination, as drivers of female job placement in paid domestic work and as factors associated with DS. Consistent with these findings, the statistical analysis showed that PDWs reported the highest adjusted prevalence of DS (14.1%, 95%CI=9.7–18.4). However, differences were statistically significant only when compared with certain groups, such as formal employees (9.4%, 95%CI=8–10.9). For Mexican working women, after adjusting for relevant covariates and confounders, the odds of DS remained higher among PDWs when compared with formal employees (OR=1.65, 95%CI=1.04–2.61).

Overall, the findings of this dissertation call for a deeper understanding of the social determinants of mental health among PDWs in Mexico and globally. Future research should focus on identifying causal links between paid domestic work and DS, particularly through longitudinal data on mental health and employment trajectories. Improving methodological quality in qualitative studies and harmonizing work-related items across existing health data collection instruments is also needed. Finally, sustaining efforts toward the formalization of paid domestic work is a key policy priority to foster favorable social conditions and improve the mental well-being of historically neglected workforce groups in Mexico, such as PDWs.