Occupational physical activity and depression risk: A systematic review and dose-response meta-analysis

Abstract

Background: The relationship between occupational physical activity (OPA) and depression remains unclear. This meta-analysis aimed to systematically evaluate the association between OPA and depression risk, including dose-response relationships. Methods: A systematic search of the PubMed and EMBASE databases was conducted and update through May 25th 2025. Observational studies investigating the relationship between OPA and depression risk were included. Random-effects models were used to calculate the pooled relative risks (RRs), and both linear and nonlinear dose-response analyses were performed. Subgroup analyses were used to explore potential sources of heterogeneity. Results: Eleven studies with 183,555 participants in total were included. The pooled RR that compared highest versus lowest OPA levels was 1.25 (95% CI: 1.12, 1.40), indicating increased depression risk with higher OPA. Linear dose-response analysis showed that each 1-hour increment in OPA was associated with a 5% elevated depression risk (RR=1.05, 95% CI: 1.01, 1.09). Subgroup analyses revealed stronger associations among males (RR=1.45, 95% CI: 1.09, 1.93) and in Asian populations (RR=1.60, 95% CI: 1.15, 2.23). Studies using depression-specific assessment tools (e.g., the Patient Health Questionnaire-9 and Center for Epidemiologic Studies-Depression Scale) have shown stronger associations with depression than those using general mental health questionnaires. Conclusions: This meta-analysis provides evidence that higher levels of OPA are associated with increased depression risk, challenging the assumption that all forms of physical activity benefit mental health. These findings highlight the importance of considering the context of physical activity and suggest the need for workplace interventions that address the unique characteristics of OPA.