title: Impact of a private sector living wage intervention on depressive symptoms among apparel workers in the Dominican Republic: a quasi-experimental study.
abstract: OBJECTIVE
  Poverty reduction interventions through cash transfers and microcredit have had mixed effects on mental health. In this quasi-experimental study, we evaluate the effect of a living wage intervention on depressive symptoms of apparel factory workers in the Dominican Republic.
  
  
  METHODS
  Two apparel factories in the Dominican Republic.
  
  
  METHODS
  The final sample consisted of 204 hourly wage workers from the intervention (99) and comparison (105) factories.
  
  
  METHODS
  In 2010, an apparel factory began a living wage intervention including a 350% wage increase and significant workplace improvements. The wage increase was plausibly exogenous because workers were not aware of the living wage when applying for jobs and expected to be paid the usual minimum wage. These individuals were compared with workers at a similar local factory paying minimum wage, 15-16 months postintervention.
  
  
  METHODS
  Workers' depressive symptoms were assessed using the Center for Epidemiologic Studies-Depression Scale (CES-D). Ordinary least squares and Poisson regressions were used to evaluate treatment effect of the intervention, adjusted for covariates.
  
  
  RESULTS
  Intervention factory workers had fewer depressive symptoms than comparison factory workers (unadjusted mean CES-D scores: 10.6 ± 9.3 vs 14.7 ± 11.6, p = 0.007). These results were sustained when controlling for covariates (β = -5.4, 95% CI -8.5 to -2.3, p = 0.001). In adjusted analyses using the standard CES-D clinical cut-off of 16, workers at the intervention factory had a 47% reduced risk of clinically significant levels of depressive symptoms compared with workers at the comparison factory (23% vs 40%).
  
  
  CONCLUSIONS
  Policymakers have long grappled with how best to improve mental health among populations in low-income and middle-income countries. We find that providing a living wage and workplace improvements to improve income and well-being in a disadvantaged population is associated with reduced depressive symptoms.
authors.affiliation: University of California Berkeley, University of California San Francisco Joint Medical Program, Berkeley, California, USA.
authors.forename: Katharine B
authors.initials: KB
authors.lastname: Burmaster
authors.affiliation: University of California Berkeley, University of California San Francisco Joint Medical Program, Berkeley, California, USA.
authors.forename: John C
authors.initials: JC
authors.lastname: Landefeld
authors.affiliation: Stanford School of Medicine, Stanford, California, USA.
authors.forename: David H
authors.initials: DH
authors.lastname: Rehkopf
authors.affiliation: University of California Berkeley School of Public Health, Berkeley, California, USA.
authors.forename: Maureen
authors.initials: M
authors.lastname: Lahiff
authors.affiliation: University of California Berkeley, University of California San Francisco Joint Medical Program, Berkeley, California, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Sokal-Gutierrez
authors.affiliation: Worker Rights Consortium, Washington DC, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Adler-Milstein
authors.affiliation: University of California Berkeley School of Public Health, Berkeley, California, USA.
authors.forename: Lia C H
authors.initials: LC
authors.lastname: Fernald
mesh_terms: D000328:Adult; D003020:Clothing; D003863:Depression / Q000517:prevention & control*; D003866:Depressive Disorder / Q000517:prevention & control; D004293:Dominican Republic; D005260:Female; D006801:Humans; D008297:Male; D066192:Manufacturing Industry; D008603:Mental Health; D011203:Poverty / Q000523:psychology*; D017149:Private Sector; D012456:Salaries and Fringe Benefits; D014937:Work / Q000523:psychology*; D017132:Workplace
keywords: MENTAL HEALTH; PUBLIC HEALTH