Labor-force participation transitions and depressive symptom onset and remission among middle-aged and older adults in China: a longitudinal analysis of CHARLS 2011–2018

Abstract Background Labor-force participation is an important social context for health, yet evidence on how transitions into and out of work relate to changes in depressive symptoms remains limited. Most previous studies have focused on static employment or retirement status or on changes in symptom scores. We examined associations of labor-force participation transitions with incident depressive symptoms and remission among middle-aged and older adults in China. Methods Using CHARLS data from 2011, 2013, 2015, and 2018, we constructed person-period records for three adjacent transition intervals. The 2018–2020 interval was retained as a measurement/context sensitivity analysis. Depressive symptoms were defined as CESD-10 score ≥ 10. Labor-force transitions were classified as stable working, labor exit, labor entry, and stable non-participation. Primary outcomes were incident depressive symptoms and remission. Logistic generalized estimating equations with exchangeable working correlation and robust standard errors were used with sequential covariate adjustment. Results The primary analysis included 42174 eligible person-period transition observations from 19570 unique participants. In the fully adjusted model, labor exit, compared with stable working, was associated with higher odds of incident depressive symptoms ( OR = 1.16, 95% CI : 1.05–1.28, P = 0.003) and lower odds of remission ( OR = 0.84, 95% CI : 0.75–0.95, P = 0.003). Labor entry was not clearly associated with incident depressive symptoms ( OR = 0.99, 95% CI : 0.87–1.12) or remission ( OR = 1.07, 95% CI : 0.94–1.23). Associations for labor exit were similar after additional adjustment for health-selection variables and baseline CESD-10 score and when analyses were restricted to observations with complete CESD-10 items. In the 2018–2020 interval alone, labor exit was not clearly associated with incident depressive symptoms ( OR = 1.00, 95% CI : 0.83–1.21). Conclusions Labor exit was associated with both higher odds of incident depressive symptoms and lower odds of remission. These findings suggest that transitions out of work may mark a period of increased mental-health vulnerability and may warrant attention in public health strategies addressing population ageing, delayed retirement, and social participation. More detailed information on reasons for labor exit and heterogeneous non-working states is needed to identify groups most likely to benefit from support.