Reported mental-health symptoms differed markedly among workers in 11 industries surveyed across Chongqing, China. After weighting the results, researchers estimated that 19.0% of workers reported depressive symptoms, 7.8% reported anxiety symptoms and 5.9% reported both. The corresponding 95% confidence intervals were 16.7% to 21.3% for depressive symptoms, 6.4% to 9.1% for anxiety symptoms and 4.8% to 7.1% for combined symptoms.
The results refer to questionnaire-defined symptoms rather than clinical diagnoses. Researchers used validated Chinese versions of the nine-item PHQ-9 and seven-item GAD-7 questionnaires, asking about depressive symptoms over the previous six months and anxiety symptoms over the previous two weeks. A score of at least 10 on each scale set the threshold, and comorbidity meant reaching both thresholds.
The highest rates depended on the sector
The industry pattern was not uniform. Depressive symptoms were most prevalent in health care and social work, at 26.1%, and least prevalent in non-metallic mineral mining, at 8.7%. Anxiety symptoms were highest in express and food delivery, at 13.1%. Comorbid symptoms were highest in express delivery, at 10.0%, education, at 9.6%, and construction, at 8.7%. Mining had the lowest comorbidity prevalence, at 1.9%, followed by leather, fur and feather manufacturing at 3.1%.
Some differences remained after adjustment for demographic, health-related and occupational characteristics. Education, health care, express delivery and construction continued to show higher odds of depression-only, anxiety-only and comorbid symptoms. Non-metallic mineral mining showed lower adjusted odds, at an odds ratio of 0.68, with a 95% confidence interval of 0.47 to 0.97. An odds ratio is a model-based comparison, not a percentage of workers. The estimate for leather and footwear manufacturing was 1.15, but its confidence interval, 0.81 to 1.62, was not statistically significant.
Pain and stress stood out in the analysis
Beyond industry, the survey showed differences between worker groups. Comorbidity prevalence was higher among workers aged 16 to 39, single participants and those reporting more sick leave. It was 16.0% among workers with more than three sick-leave days, 10.1% among those with fewer than three days and 4.2% among those with none. The prevalence was 7.7% among workers with low occupational health literacy, compared with 4.1% among those with high literacy. Depressive and anxiety symptoms also increased with longer hours, more pain sites, night or rotating shifts and occupational stress.
In the fully adjusted analysis, the strongest reported associations with comorbid symptoms were pain at more than three body sites, occupational stress and more than three days of sick leave. Their odds ratios were 5.66, 4.78 and 3.35, respectively. Working more than 55 hours a week was also associated with higher odds of comorbidity, with an odds ratio of 1.64. Younger age, being single and low occupational health literacy were associated with higher odds of one or more outcomes. Night or rotating shift work was not significantly associated with any outcome.
These findings show relationships in the survey, not proof that a job condition caused symptoms. The researchers found that physical-health indicators sharply reduced industry differences in comorbid and depressive symptoms. Occupational stress produced the largest reductions in the industry differences for anxiety, while demographic characteristics and night-shift work explained little of the observed occupational variation.
What the survey can and cannot say
The study was cross-sectional, meaning it surveyed workers at one point rather than following them over time. It included 10,112 front-line urban workers aged 16 to 59 with at least six months of work experience in 11 industries. Administrative staff were excluded. Multistage stratified cluster sampling was used across Chongqing's districts and counties, with at least 800 workers required in each industry.
For prevalence estimates, the researchers used sampling weights, poststratification and Taylor series linearization to account for the survey design and cluster effects. The models included district or county random intercepts. A Bayesian multinomial mixed-effects logistic model treated comorbidity as a four-category outcome.
The study's cross-sectional design prevents causal inference, and self-reported symptoms may introduce reporting bias. Because the research was conducted in one province-level municipality, its findings may not generalize to other regions or to all Chinese workers.
The study was supported by the Chongqing Medical Scientific Research Project, a joint project of the Chongqing Health Commission and Science and Technology Bureau, and the IMICAMS Youth Talent Development Fund. The funders reportedly had no role in conducting the study or deciding to submit it. The anonymized dataset is available from the corresponding author on reasonable request, and the authors declared no conflicts of interest.
Paper data and sources
Original title: Depressive and Anxiety Symptoms and Their Comorbidity Across Industries: Multi-Industry Cross-Sectional Study in China.
Authors: Lei Cao, Ruihong Ran, Huadong Zhang, Heling Bao
Journal/Repository: JMIR public health and surveillance
Status: Peer-reviewed
First online: 2026-08-21
DOI: 10.2196/91782
Original paper