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Country- and individual-level socioeconomic determinants of depression: multilevel cross-national comparison

  • Dheeraj Rai (a1), Pedro Zitko (a2), Kelvyn Jones (a3), John Lynch (a4) and Ricardo Araya (a1)...
Abstract
Background

The prevalence and correlates of depression vary across countries. Contextual factors such as country-level income or income inequalities have been hypothesised to contribute to these differences.

Aims

To investigate associations of depression with socioeconomic factors at the country level (income inequality, gross national income) and individual (education, employment, assets and spending) level, and to investigate their relative contribution in explaining the cross-national variation in the prevalence of depression.

Method

Multilevel study using interview data of 187 496 individuals from 53 countries participating in the World Health Organization World Health Surveys.

Results

Depression prevalence varied between 0.4 and 15.7% across countries. Individual-level factors were responsible for 86.5% of this variance but there was also reasonable variation at the country level (13.5%), which appeared to increase with decreasing economic development of countries. Gross national income or country-level income inequality had no association with depression. At the individual level, fewer material assets, lower education, female gender, economic inactivity and being divorced or widowed were associated with increased odds of depression. Greater household spending, unlike material assets, was associated with increasing odds of depression (adjusted analysis).

Conclusions

The variance of depression prevalence attributable to country-level factors seemed to increase with decreasing economic development of countries. However, country-level income inequality or gross national income explained little of this variation, and individual-level factors appeared more important than contextual factors as determinants of depression. The divergent relationship of assets and spending with depression emphasise that different socioeconomic measures are not interchangeable in their associations with depression.

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Copyright
Corresponding author
Dheeraj Rai, Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Oakfield House, Oakfield Grove, Clifton, Bristol BS8 2BN, UK. Email: dheeraj.rai@bristol.ac.uk
Footnotes
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These authors contributed equally to this work.

Declaration of interest

None.

Footnotes
References
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Country- and individual-level socioeconomic determinants of depression: multilevel cross-national comparison

  • Dheeraj Rai (a1), Pedro Zitko (a2), Kelvyn Jones (a3), John Lynch (a4) and Ricardo Araya (a1)...
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eLetters

Country- and individual-level determinants of depression

Manjeet S. Bhatia
03 April 2013

The study by Dheeraj Rai and others is an excellent one. It gives an insight into the comparison countrywide and individual parameters relatedto depression. There are however, many other important factors associated with depression e.g. past history; past history of successful treatment; family history;history of co morbid psychiatric disorder (e.g. substance abuse) or chronic physical disorder (e.g. diabetes mellitus); social factors (e.g. poor support, isolation, emigration); religious factors (lowreligiosity); poor quality of life. Literacy and economic level may be inversely linked (e.g. higher education leading to higher ambitions but lowly earning employment or unemployment; poor job satisfaction leading toemigration causing social isolation and depression; job insecurity etc.). Depression in itself leads to low productivity, poor job satisfaction and further aggravation or chronicity of depression.Country wide factors play an important role if there is mismatch between literacy and type of jobs available or there is economic regression and loss of jobs. More studies are needed to study the interplay of these factors in the aetiology, continuation or outcome of depression.

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Conflict of interest: None declared

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