The role of labor market inequalities in explaining 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 older US women compared to men. Methods: We analyze data from 35,699 US adults aged 50-80 years that participated in the Health and Retirement Study. We calculate the gender gap as the difference in the prevalence of elevated depressive 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 50-80 with the longitudinal g-formula. We introduce four nested interventions by assigning women the same probabilities of A) being in an employment category, B) occupation class, C) current income, and D) prior income group as men, conditional on women’s health and family status until age 70. Findings: The gender gap in depression risk is 2.9%-points at ages 50-51 which increases to 7.6%-points at ages 70-71. Intervention A decreases the gender gap over ages 50-71 by 1.2%-points (95%CI for change: -2.81 to 0.4), intervention D by 1.64%-points (95%CI for change: -3.28 to -0.15) or 32% (95%CI: 1.39 to 62.83), and the effects of interventions B and C are in between those of A and D. The impact is particularly large for Hispanics and low educated groups. Interpretation: Gender inequalities at the labor market substantially explain the gender gap in depression risk in older US adults. Reducing these inequalities has the potential to narrow the gender gap in depression.