Socio-economic status over the life-course and depressive symptoms in men and women in Eastern Europe☆
Received 26 January 2007; received in revised form 27 April 2007; accepted 27 April 2007.
Abstract
Objective
Research into social inequalities in depression has studied western populations but data from non-western countries are sparse. In this paper, we investigate the extent of social inequalities in depression in Eastern Europe, the relative importance of social position at different points of the life-course, and whether social patterning of depression differs between men and women.
Method
A cross-sectional study examined 12,053 men and 13,582 women in Russia, Poland and the Czech Republic. Depressive symptoms (16 or above on the CESD-20) were examined in relation to socio-economic circumstances at three phases of the life-course: childhood (household amenities and father's education); own education; current circumstances (financial difficulties and possession of household items).
Results
Pronounced social differences in depression exist in men and women throughout Eastern Europe. Depression was largely influenced by current circumstances rather than by early life or education, with effects stronger in Poland and Russia. Odds ratios in men for current disadvantage were 3.16 [95% CI: 2.57–3.89], 3.16 [2.74–3.64] and 2.17 [1.80–2.63] in Russia, Poland and the Czech Republic respectively. Social variables did not explain the female excess in depression, which varied from 2.91 [2.58–3.27] in Russia to 1.90 [1.74–2.08] in Poland. Men were more affected by adult disadvantage than women, leading to narrower sex differentials in the presence of disadvantage.
Limitations
Cross-sectional data with recall of childhood conditions were used.
Conclusion
Current social circumstances are the strongest influence on increased depressive symptoms in countries which have recently experienced social changes.
aInternational Institute for Health and Society, Department of Epidemiology and Public Health, University College London, UK
bDepartment of Epidemiology and Population Studies, Jagiellonian University, Krakow, Poland
cInstitute of Internal Medicine, Russian Academy of Medical Sciences, Novosibirsk, Russia
dCentre for Environmental Health, National Institute of Public Health, Prague, Czech Republic
Corresponding author. Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK. Tel.: +44 20 7679 1725; fax: +44 20 7813 0280.
☆ Contributors: Amanda Nicholson: corresponding author, participated in the analysis of data and writing of paper. She had full access to all the data in the study and had final responsibility for the decision to submit for publication. Hynek Pikhart participated in the design of the study, data collection, analysis of data and writing of paper. Andrzej Pajak participated in the design of study, data collection and writing the paper. Sofia Malyutina participated in the design of study, data collection and writing the paper. Ruzena Kubinova participated in the design of study, data collection and writing the paper. Anne Peasey participated in the design of the study, data collection, analysis of data and writing of paper. Roman Topor-Madry participated in the design of study, data collection and writing the paper. Yuri Nikitin participated in the design of study, data collection and writing the paper. Nada Capkova participated in the design of study, data collection and writing the paper. Martin Bobak participated in the design of the study, data collection, analysis of data and writing of paper. Michael Marmot participated in the design of study, data collection and writing the paper. All authors contributed to and have approved the final manuscript. Conflict of interest statements: Amanda Nicholson received an honorarium of £200 for writing the following article: Review article: Psychiatric disorders and the risk of CHD. For Current Medical Literature-Psychiatry. 2006. There are no other conflicts of interest. Role of funding source: This study is funded by a grant from the Wellcome Trust “Determinants of Cardiovascular Diseases in Eastern Europe: A multi-centre cohort study” (Reference number 064947/Z/01/Z); a grant from the National Institute on Aging “Health disparities and aging in societies in transition (the HAPIEE study)”, grant number 1R01 AG23522-01; and a grant from MacArthur Foundation “Health and Social Upheaval (a research network)”. MM holds a UK Medical Research Council Research Professorship. The funding sources had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.
ABSTRACT