Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2016

Open Access 01-12-2016 | Research article

The role of socio-economic status in depression: results from the COURAGE (aging survey in Europe)

Authors: Aislinne Freeman, Stefanos Tyrovolas, Ai Koyanagi, Somnath Chatterji, Matilde Leonardi, Jose Luis Ayuso-Mateos, Beata Tobiasz-Adamczyk, Seppo Koskinen, Christine Rummel-Kluge, Josep Maria Haro

Published in: BMC Public Health | Issue 1/2016

Login to get access

Abstract

Background

Low socio-economic status (SES) has been found to be associated with a higher prevalence of depression. However, studies that have investigated this association have been limited in their national scope, have analyzed different components of SES separately, and have not used standardized definitions or measurements across populations. The aim of the current study was to evaluate the association between SES and depression across three European countries that represent different regions across Europe, using standardized procedures and measurements and a composite score for SES.

Method

Nationally-representative data on 10,800 individuals aged ≥18 from the Collaborative Research on Ageing in Europe (COURAGE) survey conducted in Finland, Poland and Spain were analyzed in this cross-sectional study. An adapted version of the Composite International Diagnostic Interview was used to identify the presence of depression, and SES was computed by using the combined scores of the total number of years educated (0–22) and the quintiles of the country-specific income level of the household (1–5). Multivariable logistic regression was used to assess the association between SES and depression.

Results

Findings reveal a significant association between depression and SES across all countries (p ≤ 0.001). After adjusting for confounders, the odds of depression were significantly decreased for every unit increase in the SES index for Finland, Poland and Spain. Additionally, higher education significantly decreased the odds for depression in each country, but income did not.

Conclusion

The SES index seems to predict depression symptomatology across European countries. Taking SES into account may be an important factor in the development of depression prevention strategies across Europe.
Literature
1.
2.
3.
Wittchen HU, Jacobi F. Size and burden of mental disorders in Europe—a critical review and appraisal of 27 studies. Eur Neuropsychopharm. 2005;15(4):357–76.CrossRef
4.
5.
Ayuso-Mateos JL, Vazquez-Barquero JL, Dowrick C, Lehtinen V, Dalgard OS, Casey P, Wilkinson C, Lasa L, Page H, Dunn G, Wilkinson G, ODIN Group. Depressive disorders in Europe: prevalence figures from the ODIN study. Brit J Psychiatr. 2001;179:308–16.CrossRef
6.
World Health Organization. The global burden of disease: 2004 Update. Geneva: The World Health Organization; 2008.
7.
Kovess-Masféty V, Alonso J, de Graaf R, Demyttenaere K. A European approach to rural–urban differences in mental health: the ESEMeD 2000 comparative study. Can J Psychiatry. 2005;50(14):926–36.PubMed
8.
Kessler RC, Aguilar-Gxiola S, Alonso J, Chatterji S, Lee S, Ormel J, Üstün TB, Wang PS. The global burden of mental disorders: an update from the WHO World Mental Health (WMH) surveys. Epidemiol Psichiatr Soc. 2009;18(1):23–33.CrossRefPubMedPubMedCentral
9.
Pikhartova J, Chandola T, Kubinova R, Bobak M, Nicholson A, Pikhart H. Neighbourhood socioeconomic indicators and depressive symptoms in the Czech Republic: a population based study. Int J Publ Health. 2009;54:283–93.CrossRef
10.
Krieger N, Williams DR, Moss NE. Measuring social class in US public health research: concepts, methodologies, and guidelines. Annu Rev Publ Health. 1997;18:341–78.CrossRef
11.
Andrade L, Caraveo-Anduaga JJ, Berglund P, et al. Crossnational comparisons of the prevalences and correlates of mental disorders. Bull World Health Organ. 2000;78:413–26.
12.
Muntaner C, Eaton WW, Miech R, O’Campo P. Socioeconomic position and major mental disorders. Epidemiol Rev. 2004;26:53–62.CrossRefPubMed
13.
Jo S-J, Yim HW, Bang MH, Lee MO, Jun T-Y, Choi J-S, et al. The association between economic status and depressive symptoms: an individual and community level approach. Psychiatry Investigation. 2011;8(3):194–200.CrossRefPubMedPubMedCentral
14.
Lorant V, Croux C, Weich S, Deliege D, Mackenbach J, Ansseau M. Depression and socio-economic risk factors: 7-year longitudinal population study. Brit J Psychiat. 2007;190:293–8.CrossRefPubMed
15.
Patal V, Araya R, de Lima M, Ludermir A, Todd C. Women, poverty and common mental disorders in four restructuring societies. Soc Sci Med. 1999;49:1461–71.CrossRef
16.
Li Z, Page A, Martin G, Taylor R. Attributable risk of psychiatric and socio-economic factors for suicide from individual-level, population-based studies: a systematic review. Soc Sci Med. 2011;72(4):608–16.CrossRefPubMed
17.
Ustun T, Chatterji S, Mechbal A, Murray C, WHS Collaborating Groups. Quality assurance in surveys: standards, guidelines and procedures. In: Household sample surveys in developing and transition countries. New York. 2005.
18.
Galobardes B, Shaw M, Lawlow DA, Lynch JW, Davy Smith G. Indicators of socioeconomic position (part 1). J Epidemiol Commun H. 2006;60:7–12.CrossRef
19.
OECD. Divided we stand: why income inequality keeps rising. Paris: OECD Publishing; 2011.
20.
Eikemo TA, Huisman M, Bambra C, Kunst AE. Health inequalities according to educational level in different welfare regimes: a comparison of 23 European countries. Sociol Health Illn. 2008;30:565–82.CrossRefPubMed
21.
22.
Perales J, Martin S, Ayuso-Mateos JL, et al. Factors associated with active aging in Finland, Poland, and Spain. Int Psychogeriatr. 2014;15:1–13.
23.
Haro JM, Arbabzadeh-Bouchez S, Brugha TS, de Girolamo G, Guyer ME, Jin R, Lepine JP, Mazzi F, Reneses B, Vilagut G, Sampson NA, Kessler RC. Concordance of the Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health surveys. Int J Methods Psychiatr Res. 2006;15(4):167–80.CrossRefPubMed
24.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: Author; 1994.
25.
Kaplan GA, Roberts R, Camacho TC, Coyne JC. Psychosocial predictors of depression. Prospective evidence from the human population laboratory studies. Am J Epidemiol. 1987;125(2):206–20.PubMed
26.
Sargeant K, Bruce ML, Florio LP. Factors associated with 1-year outcome of major depression in the community. Arch Gen Psychiat. 1990;47:519–26.CrossRefPubMed
27.
Miech RA, Shanahan MJ. Socioeconomic status and depression over the life course. J H Soc Behav. 2000;41(2):162–76.CrossRef
28.
Mirowsky J, Ross CE. Education, personal control, lifestyle and health–a human capital hypothesis. Res Aging. 1998;20:415–49.CrossRef
29.
Lorant V, Deliege D, Eaton W, Robert A, Philippot P, Ansseau M. Socioeconomic inequalities in depression: a meta-analysis. Am J Epidemiol. 2003;157(2):98–112.CrossRefPubMed
30.
Virtanen M, Kivimaki M, Elovainio M, Linna A, Pentti J, Vahtera J. Neighbourhood socioeconomic status, health and working conditions of school teachers. J Epidemiol Commun H. 2007;61(4):326–30.CrossRef
31.
Liberatos P, Link BG, Kelsey JL. The measurement of social class in epidemiology. Epidemiol Rev. 1988;10:87–121.PubMed
32.
Katsarou A, Tyrovolas S, Psaltopoulou T, Zeimbekis A, Tsakountakis N, Bountziouka V, Gotsis E, Metallinos G, Polychronopoulos E, Lionis C, Panagiotakos D. Socio-economic status, place of residence and dietary habits among the elderly: the Mediterranean islands study. Public Health Nutr. 2010;13(10):1614–21.CrossRefPubMed
33.
Haug MR. Measurement in social stratification. Annu Rev Sociol. 1977;3:51–77.CrossRef
34.
Stevens G, Cho JH. Socioeconomic indexes and the new 1980 census occupational classification scheme. Soc Sci Res. 1985;14:142–68.CrossRef
35.
Stravraky KM, Kincade JE, Steward MA, Donner AP. The effect of socioeconomic factors on the early prognosis of cancer. J Chronic Dis. 1987;40:237–44.CrossRef
36.
Stockwell EG. A critical examination of the relationship between socioeconomic status and mortality. Am J Pub H. 1963;53:956–64.CrossRef
37.
Rodríguez-Pose A, Tselios V. Education and income inequality in the regions of the European union SERC. London: Department of Geography & Environment, London School of Economics; 2008.
38.
Gan Z, Li Y, Xie D, Shao C, Yang F, Shen Y, et al. The impact of educational status on the clinical features of major depressive disorder among Chinese women. J Affect Disord. 2012;136(3):988–92.CrossRefPubMedPubMedCentral
39.
Bjelland I, Krokstad S, Mykletun A, Dahl A, Tell GS, Tambs K. Does a higher education level protect against anxiety and depression? The HUNT study. Soc Sci Med. 2008;66(6):1334–45.CrossRefPubMed
40.
Molarius A, Berglund K, Eriksson C, Eriksson HG, Lindén-Boström M, Nordström E, Persson C, Sahlqvist L, Starrin B, Ydreborg B. Mental health symptoms in relation to socio-economic conditions and lifestyle factors–a population-based study in Sweden. BMC Public Health. 2009;9:302.CrossRefPubMedPubMedCentral
41.
Lahelma E, Laaksone M, Marikainen P, Rahkonena O, Sarlio-Lähteenkorva S. Multiple measures of socioeconomic circumstances and common mental disorders. Soc Sci Med. 2006;63:1383–99.CrossRefPubMed
42.
43.
44.
45.
McKenzie K, Murray A, Booth T. Do urban environments increase the risk of anxiety, depression and psychosis? An epidemiological study. J Affect Disorders. 2013;150(3):1019–24.CrossRefPubMed
46.
Georg Hsu LK, Wan YM, Chang H, Summergrad P, Tsang BY, Chen H. Stigma of depression is more severe in Chinese Americans than Caucasian Americans. Psychiatry. 2008;71(3):210–8.CrossRefPubMed
47.
Berger JL, Addis ME, Reilly ED, Green JD. Effects of gender, diagnostic labels, and causal theories on willingness to report symptoms of depression. J Soc Clin Psych. 2012;31(5):439–57.CrossRef
48.
Tuesca-Molina R, Fierro Herrera N, Molinares Sosa A, Oviedo Martínez F, Polo Arjona Y, Polo Cueto J, Sierra Manrique I. Socializing groups as protective factor against depression in elderly people. Barranquilla, Colombia. 2003;77(5):595–604.
49.
Kent ST, McClure LA, Crosson WL, Arnett DK, Waley VG, Sathiakumar N. Effect of sunlight exposure on cognitive function among depressed and non-depressed participants: a REGARDS cross-sectional study. Environ Health. 2009;8:34.CrossRefPubMedPubMedCentral
50.
Skarupski KA, Tangney CC, Li H, Evans DA, Morris MC. Mediterranean diet and depressive symptoms among older adults over time. J Nutr Health Aging. 2013;17(5):441–5.CrossRefPubMedPubMedCentral
51.
Gomez-Beneyto M, Asensio A, Berenguer MJ. Desinstitucionalización de enfermos mentales crónicos sin recursoscomunitarios. In: Espinosa J, editor. Cronicicidad en Psiquiatria. Madrid: Mayoría editorial; 1996.
52.
Wiggins RD, Schofield P, Sacker A, Head J, Bartley M. Social position and minor psychiatric morbidity over time in the British household panel survey 1991–1998. J Epidemiol Commun H. 2004;58:779–87.CrossRef
53.
Meertens V, Scheepers P, Tax B. Depressive symptoms in the Netherlands 1975–1996: a theoretical framework and an empirical analysis of socio-demographic characteristics, gender differences and changes over time. Sociol Health Illn. 2003;25:208–31.CrossRefPubMed
54.
Huijts T, Eikemo TA, Skalicka V. Income-related health inequalities in the Nordic countries: examining the role of education, occupational class, and age. Soc Sci Med. 2010;71:1964–72.CrossRefPubMed
55.
World Health Organization. Social inequalities in health in Poland. Geneva: WHO; 2012.
Metadata
Title
The role of socio-economic status in depression: results from the COURAGE (aging survey in Europe)
Authors
Aislinne Freeman
Stefanos Tyrovolas
Ai Koyanagi
Somnath Chatterji
Matilde Leonardi
Jose Luis Ayuso-Mateos
Beata Tobiasz-Adamczyk
Seppo Koskinen
Christine Rummel-Kluge
Josep Maria Haro
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2016
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-016-3638-0

Other articles of this Issue 1/2016

BMC Public Health 1/2016 Go to the issue

Research article

Weekday-weekend patterns of physical activity and screen time in parents and their pre-schoolers

Research article

Effects of an exclusive breastfeeding intervention for six months on growth patterns of 4–5 year old children in Uganda: the cluster-randomised PROMISE EBF trial

Research article

Prevalence of high-risk human papillomavirus and abnormal pap smears in female sex workers compared to the general population in Antwerp, Belgium

Research article

A systematic review on the clustering and co-occurrence of multiple risk behaviours

Research article

Niche modeling predictions of the potential distribution of Marmota himalayana, the host animal of plague in Yushu County of Qinghai

Erratum

Erratum to: ‘The educational gradient of obesity increases among Swedish pregnant women: a register-based study’