To ascertain the direction of causality and differences by sex between major depressive disorder (MDD) and labor market outcomes in the US population, we used structural equation models separately for males and females to assess prospectively the interdependency of depression and labor market outcomes at Waves 1 (2001–2002) and 2 (2004–2005) of the National Epidemiologic Survey on Alcohol and Related Conditions. Diagnosis of MDD used DSM-IV criteria. We found that MDD at Wave 1 predicted being out of the labor force for males at Wave 2 (p = 0.006) and being in the labor force at Wave 1 was associated with lower probability of MDD at Wave 2 (p = 0.049). Among males in the labor force, MDD at Wave 1 was negatively associated with employment at Wave 2 (p = 0.047), and employment at Wave 1 was negatively associated with MDD at Wave 2 (p < 0.001). For women, there was no association between MDD and labor force participation. However, among women in the labor force, MDD at Wave 1 was negatively associated with employment at Wave 2 (p = 0.013) and being employed at Wave 1 was negatively associated with MDD at Wave 2 (p < 0.0001). These results indicate that MDD and negative labor market outcomes are associated with one another at both time points, but the effects differ by sex. To reduce the economic and social burden of MDD, these differences should be considered in clinical practice, vocational rehabilitation, and in the design of social policies.

为了确定美国人群中主要抑郁症（MDD）与劳动力市场结果之间因果关系和性别差异的方向，我们分别针对男性和女性使用结构方程模型来前瞻性评估在Waves 1中抑郁与劳动力市场结果之间的相互依赖性（2001-2002年）和第2期（2004-2005年）进行了关于酒精和相关疾病的全国流行病学调查。诊断MDD使用DSM-IV标准。我们发现，在第1浪中，MDD预测在第2浪中男性不在劳动力中（p  = 0.006），而在第1浪中处于MDL中，这与第2浪中MDD的概率较低相关（p = 0.049）。在劳动力中的男性中，第一波的MDD与第二波的就业呈负相关（p = 0.047），第一波的就业与第二波的MDD负相关（p <0.001）。对于妇女而言，MDD与劳动力参与之间没有关联。但是，在劳动力中的妇女中，第一波的MDD与第二波的就业呈负相关（p = 0.013），在第一波受雇的女性与第二波的MDD呈负相关（p <0.0001）。这些结果表明，MDD和负面的劳动力市场结果在两个时间点都相互关联，但影响因性别而异。为了减轻MDD的经济和社会负担，应在临床实践，职业康复和社会政策设计中考虑这些差异。