Gender-Specific Pathways Linking Unemployment and Depression: A Cross-National Panel Study, 2010-2023

Objective: To examine whether population-level associations between national unemployment and depression burden differ for women and men across 18 major global economies from January 1, 2010 to December 31, 2023. Patients and Methods: This cross-national longitudinal panel study analyzed gender-disaggregated, country-level annual data across predefined valid observation years (2010, 2013, and from January 1, 2015 to December 31, 2023) from 18 Group of twenty nations. Age-standardized depression disability-adjusted life year rates (Global Burden of Disease 2021) served as the primary outcome; international labor organization standardized 25-64-year gender-specific unemployment rates were the exposure. Linear mixed-effects models with random country and year intercepts were specified as the primary analytic framework, adjusted for log-transformed per capita gross domestic product, Gini coefficient, and annual health expenditure (% gross domestic product). Country-level Pearson correlations and multi-dimensional sensitivity analyses were conducted to assess cross-national heterogeneity and result robustness. Substantial cross-country heterogeneity existed, with within-nation unemployment-depression correlation coefficients ranging from -0.87 to 0.85; gendered effects were amplified in high-income countries. All sensitivity analyses confirmed the robustness of the primary findings. Conclusion: Macroeconomic unemployment growth generates disproportionately larger population-level depression burden among women across major global economies. Public health surveillance, labor stabilization policies, and clinical mental health intervention frameworks must integrate gender-sensitive design to mitigate female mental health risks during economic downturns.