# Absence of a Written Employment Contract and Health Outcomes Among Employed Adults in Chile

## TL;DR

This study finds that workers in Chile without written employment contracts have higher rates of anxiety and depression, showing how job informality affects mental health and quality of life.

## Contribution

The study provides updated evidence from Chile linking labor informality, as indicated by the absence of written contracts, to psychological health outcomes.

## Key findings

- Workers without written contracts have higher odds of anxiety and depressive symptoms.
- Contract absence is associated with lower quality of life but not strongly with physical health conditions.
- The study highlights the importance of employment conditions as a social determinant of psychological well-being.

## Abstract

Public health relevance—How does this work relate to a public health issue?
Informal employment remains widespread in Latin America and represents a structural determinant of health and social inequality.This study examines whether the absence of a written employment contract, as a proxy of labor informality, is associated with health and well-being outcomes among employed adults in Chile.

Informal employment remains widespread in Latin America and represents a structural determinant of health and social inequality.

This study examines whether the absence of a written employment contract, as a proxy of labor informality, is associated with health and well-being outcomes among employed adults in Chile.

Public health significance—Why is this work of significance to public health?
Using nationally representative survey data from Chile (ENSEX 2022–2023), the study provides updated evidence on the relationship between contractual informality and multiple health indicators.The findings show that workers without a written contract have higher odds of anxiety and depressive symptoms and lower quality of life, highlighting the relevance of employment conditions for psychological well-being.

Using nationally representative survey data from Chile (ENSEX 2022–2023), the study provides updated evidence on the relationship between contractual informality and multiple health indicators.

The findings show that workers without a written contract have higher odds of anxiety and depressive symptoms and lower quality of life, highlighting the relevance of employment conditions for psychological well-being.

Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health?
Policies aimed at improving workers’ health should consider employment quality and informality as key social determinants of well-being.Strengthening labor formalization and expanding occupational health strategies to include workers in informal employment may contribute to reducing health inequalities.

Policies aimed at improving workers’ health should consider employment quality and informality as key social determinants of well-being.

Strengthening labor formalization and expanding occupational health strategies to include workers in informal employment may contribute to reducing health inequalities.

Precarious and informal employment has been increasingly recognized as a key social determinant of health, particularly in countries of the Global South. In Chile, despite relatively strong labor institutions, informal employment remains widespread, yet contemporary evidence on its health implications is limited. This study examines the association between the absence of a written employment contract, used as an indicator of labor informality, and multiple health and well-being outcomes among employed adults in Chile. A cross-sectional analysis was conducted using data from the nationally representative 2022–2023 National Health and Sexuality Survey (ENSEX), restricted to the urban employed population (n = 5193). Informal employment was defined by self-reported absence of a written contract. Health outcomes included perceived general health, quality of life, physician-diagnosed conditions, and recent anxiety–depressive symptoms assessed with the PHQ-4. Weighted descriptive analyses and logistic regression models were estimated, accounting for the complex survey design and adjusting for sex, age, and educational level. Approximately 12.8% of employed individuals reported not having a written contract. Contract absence was associated with higher odds of anxiety–depressive symptoms and lower odds of reporting good quality of life after adjustment. Associations with general health and chronic physical conditions were weaker and not statistically significant. These findings suggest that contractual informality is particularly linked to reduced psychological well-being and quality of life, highlighting the relevance of informal employment as a public health concern beyond traditional disease outcomes.