Background Unpaid labour as a determinant of health is under-researched, especially in low- and middle-income countries where women bear a disproportionate load of unpaid labour. Moreover, the double burden of employment and unpaid labour has been linked to mental health implications. This study explores the association between unpaid labour and mental health in Lebanon, examining gender and employment moderation effects.

Methods Data from a national cross-sectional study conducted in Lebanon in January-February 2024 was analysed. Adults aged 19-64 years were sampled through random digital dialling and surveyed via telephone. The outcomes were depression and anxiety, each defined as having scores of PHQ-9 and GAD-7 ≥ 10, respectively. The number of hours spent on unpaid labour were quantified by enquiring about time spent on eleven tasks in the past week. The main exposures were total hours spent on unpaid labour overall, and hours spent on housework, maintenance/gardening tasks, childcare, and adult care categorized into quartiles. Multiple logistic regression models assessed the associations controlling for potential confounders. Gender and employment interaction terms were considered and assessed.

Results Preliminary results included 1,400 respondents with a median age of 38 years, 48% were females, and 56% were employed. A third of the sample presented with anxiety and 44% with depression. Total hours of unpaid labour, housework and adult care were associated with depression. The adjusted odds of depression were 1.66 (95%CI:1.15-2.39) among individuals in the highest quartile of total hours compared to the lowest. Being in the highest quartile of housework increased the adjusted odds ratios (aOR) of depression to 1.79 (95%CI:1.20-2.66), and for adult care, the same comparison presented an aOR of 1.58 (95%CI:1.20-2.09). Gender significantly moderated the association between depression and maintenance/gardening tasks with males in highest quartile presenting an aOR of 1.78 (95%CI:1.22-2.62) compared to the lowest. Similarly, there was a significant association between adult care and depression in employed individuals, (aOR in the highest quartile was 1.92 (95%CI:1.32-2.81) compared to the lowest quartile). Only time spent on adult care was significantly associated with anxiety, with an aOR of 1.44 (95%CI:1.09-1.92) for individuals in the highest quartile compared to quartile 1.

Conclusion These findings underscore the importance of considering the multifaceted nature of unpaid labour in understanding its relationship with mental health. Gender and employment did not moderate the relationship, as expected. Further consideration of socio-cultural expectations of unpaid labour is necessary to understand how gendered responsibilities may influence mental health.