The role of labor market inequalities in the gender gap in depression risk among older US adults

BACKGROUND: We aim to investigate to what extent gender inequality at the labor market explains higher depression risk for women than men among older US adults. METHODS: We analyze data for 35,699 US adults aged 50-70 years that participated in the Health and Retirement Study. We calculate the gender gap as the difference in the prevalence of elevated depression symptoms ( > = 3, 8-item Center for Epidemiological Studies Depression Scale) between women and men. We employ a dynamic causal decomposition and simulate the life course of a synthetic cohort from ages 50 to 80 with the longitudinal g-formula. We introduce four nested interventions and assign women the same probabilities of being in a labor force category, occupation class, current income, and prior income as men conditional on women's health and family status until age 70. FINDINGS: The gender gap in depression risk is 2.9 percentage points at age 50 which increases to 7.6 per 100 at age 70. Giving women the same employment, occupation, and income opportunities as men decreases the gap on average over ages 50-71 by 1.2%-points (95%CI: -3 to 0.5), 1.2%-points (95%CI: -3 to 0.5), and 1.3%-points (95%CI: -3.2 to 0.3), respectively and 1.6%-points (95%CI: -3.5 to 0), or approximately one third, if we additionally intervene on prior income. The impact of the simulated intervention is particularly large for Hispanics and low-educated groups. INTERPRETATION: Policies that equalize labor market opportunities may reduce depression risk in older women and contribute up to one-third to the gender gap in depression risk. KEY MESSAGES: • We disentangle the complex relationship between gender, labor market and mental health in older US adults in an innovative life course approach with the help of hypothetical interventions. • Equalizing opportunities at the labor market reduces the gender depression gap most in groups with the largest gender depression gap, i.e. Hispanics and low educated groups.