Mental health distress, perceived stress, and subjective health status in informal mining: Evidence from artisanal miners in Ghana

Objective Anxiety and depressive symptoms are important yet under-recognized mental health concerns in informal labor sectors in Africa. However, their association with perceived physical health in high-risk occupational settings such as artisanal and small-scale mining (ASM) remains poorly understood. This study examined the associations between depressive and anxiety symptoms and self-rated health (SRH) among ASM in Ghana, and explored whether perceived stress and sleep problems may help explain these associations. Methods We recruited 664 ASM (mean age = 28.8 years, SD = 8.2; males = 84.3%) from Ghana. Depressive and anxiety symptoms were assessed using the PHQ-9 and GAD-7, respectively. SRH was measured using the MOS SF-36 SRH item, and perceived stress was assessed using the PSS-4. Multivariable linear regression and bootstrapped mediation models were used to examine direct and indirect associations. We also examined whether the anxiety symptoms –SRH association differed by age group. Results Nearly 40% of the sample reported suboptimal SRH. Depressive symptoms (B = .321, p < 0.001) and anxiety symptoms (B = .431, p < 0.001) were significantly associated with poorer SRH after full adjustment. Notably, the anxiety symptoms ─SRH association was more marked among older miners (36+ years) compared to their younger counterparts. Perceived stress partially mediated both associations, accounting for 13.4% of the total effect of depressive symptoms (B = .100, 95% CI [.035, .167]) and 11.4% of the effect of anxiety (B = .064, 95% CI [.026, .106]). Conclusions Depressive and anxiety symptoms were associated with poorer self-rated health among artisanal and small-scale miners in Ghana. Perceived stress may partly account for these associations. The relationship between anxiety symptoms and self-rated health appeared stronger among older miners. These findings underscore the relevance of mental health in shaping perceived health in informal occupational settings and suggest that stress-related factors may be important targets for intervention.