The educational patterning of health-related adversities in individuals with major depression

Klabbers, G.; Bosma, H.; Van der Does, A.J.W.; Vogelzangs, N.; Kempen, G.I.J.M; Van Eijk, J.Th.M.; Penninx, B.W.J.H.

doi:10.1016/j.jad.2010.02.128

« Previous Next »Journal of Affective Disorders
Volume 126, Issue 1 , Pages 96-102, October 2010

The educational patterning of health-related adversities in individuals with major depression

G. Klabbers
- Department of Social Medicine, School CAPHRI, Maastricht University, Maastricht, The Netherlands
- Corresponding author. Maastricht University, Dept. of Social Medicine, P.O. Box 616, 6200 MD Maastricht, The Netherlands. Tel.: +31 43 3882291; fax: +31 43 3884169.
H. Bosma
- Department of Social Medicine, School CAPHRI, Maastricht University, Maastricht, The Netherlands
A.J.W. Van der Does
- Institute of Psychology, Leiden University and Department of Psychiatry, Leiden University Medical Centre, The Netherlands
N. Vogelzangs
- Department of Psychiatry and the EMGO Institute of Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
G.I.J.M Kempen
- Department of Health Care and Nursing Science, School CAPHRI, Maastricht University, Maastricht, The Netherlands
J.Th.M. Van Eijk
- Department of Social Medicine, School CAPHRI, Maastricht University, Maastricht, The Netherlands
B.W.J.H. Penninx
- Department of Psychiatry and the EMGO Institute of Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
- Institute of Psychology, Leiden University and Department of Psychiatry, Leiden University Medical Centre, The Netherlands
- Department of Psychiatry, University Medical Centre Groningen, Groningen, The Netherlands

Received 27 November 2009; received in revised form 22 February 2010; accepted 22 February 2010.

Abstract

Background

Major depressive disorder and depression severity are socially patterned, disfavouring individuals from lower socioeconomic groups. Depressive disorders are associated with several adverse health-related outcomes. We examined the educational patterning of somatic health, lifestyles, psychological function and treatment modalities in individuals suffering from major depressive disorder.

Methods

We used cross-sectional medical and psychiatric data from 992 participants of The Netherlands Study of Depression and Anxiety (NESDA) with a diagnosed current major depressive disorder. Associations of education with somatic, lifestyle-related, and psychological outcomes, and with treatment modalities, adjusted for depression severity, were examined by means of (multinomial and binary) logistic and linear regression analyses.

Results

In addition to and independent of major depressions being more severe in the less educated patients, metabolic syndrome, current smoking, low alcohol consumption, hopelessness and low control were more prevalent in a group of less educated individuals suffering from major depression, compared with their more highly educated peers. The less educated persons were more likely to be treated with antidepressant medication and less likely to receive psychotherapy treatment. None of these observations were explained by a higher depression severity in the less educated group.

Limitations

The cross-sectional design does not allow us to make direct causal inferences regarding the mutual influences of the different health-related outcomes.

Conclusions

Further research should explore the necessity and feasibility of routine screening for additional health risk, particularly among less educated depressed individuals.

Keywords: Major depressive disorder, Educational inequalities, Metabolic syndrome, Lifestyle, treatment inequalities, Psychological function