Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2019 Apr 24;19(1):430.
doi: 10.1186/s12889-019-6730-4.

Income and education predict elevated depressive symptoms in the general population: results from the Gutenberg health study

Jasmin Schlax  1 , Claus Jünger  2 , Manfred E Beutel  1 , Thomas Münzel  3   4 , Norbert Pfeiffer  5 , Philipp Wild  3   2   6   4 , Maria Blettner  7 , Jasmin Ghaemi Kerahrodi  1 , Jörg Wiltink  1 , Matthias Michal  8   9
Affiliations
Observational Study

Income and education predict elevated depressive symptoms in the general population: results from the Gutenberg health study

Jasmin Schlax et al. BMC Public Health. .

Abstract

Background: Socioeconomic status (SES) has a strong association with depression or physical and mental health in general. However, as SES is a multifaceted construct these associations are not easy to explain. Further, there are several indicators and many studies only investigating two or less indicators at the same time. Therefore, this study aims to analyze the cross-sectional and longitudinal association of three defined SES dimensions (education, occupational position and household net-income) with the occurrence of elevated symptoms of depression relative to the impact of important covariates.

Methods: The study included observational data from 12,484 participants of the Gutenberg Health Study. The outcome was "elevated depressive symptoms" as defined by Patient Health Questionnaire (PHQ-2) ≥ 2 at the 2.5-year follow-up. Regression coefficients were adjusted for baseline covariates (age, sex, partnership, depression, anxiety, medical history of depressive or anxiety disorder and major medical diseases (MMD)) in addition to SES sum score and the three single indicators. We further examined interaction terms of the SES with sex, partnership and major medical diseases. We analyzed the sample stratified by elevated depressive symptoms at baseline, as we expected different trajectories in both subgroups.

Results: SES, education and household net-income were lower in the group of persons with PHQ-2 ≥ 2 at baseline, and they predicted the occurrence of PHQ-2 ≥ 2 at 2.5 year follow-up in the group of persons without elevated depressive symptoms at baseline after multivariable adjustment (SES: Odds Ratio (OR) 0.96, 0.95-0.98, p < 0.0001; education: OR 0.96, 0.93-0.99, p = 0.036; household net-income: OR 0.96, 0.92-0.99, p = 0.046) but not in the group of persons with elevated depressive symptoms at baseline. Further, we found that the impact of major medical diseases on the development of elevated depressive symptoms was buffered by high income. In addition, living in a partnership buffered the impact of a low occupational position.

Conclusions: Regarding the SES, the dimensions education and household net-income seem to play the most important role for socioeconomic inequalities in persons in Mid-West Germany with depressive symptoms.

Trial registration: Reference no. 837.020.07; original vote: 22.3.2007, latest update: 20.10.2015.

Keywords: Depression; Education; Income; Occupation; SES; Socioeconomic status.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

The study protocol and study documents were approved by the local ethics committee of the Medical Chamber of Rhineland-Palatinate, Germany (reference no. 837.020.07; original vote: 22.3.2007, latest update: 20.10.2015) and by the local and federal data safety commissioners. Informed consent was obtained written by all participants of the GHS.

Consent for publication

Not Applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Interaction between household net-income and MMD in the group without depressive symptoms at T0. Legend. MMD = major medical disease. PHQ-2 ≥ 2, yes, in %. Differences tested for significance via Pearson chi2
Fig. 2
Fig. 2
Interaction between occupational position and living with partner in group without depressive symptoms at T0. Legend. PHQ-2 ≥ 2, yes, in %. Differences tested for significance via Pearson chi2
See this image and copyright information in PMC

References

    1. Marmot M. Social determinants of health inequalities. Lancet. 2005;365:1099–1104. doi: 10.1016/S0140-6736(05)74234-3. - DOI - PubMed
    1. Alegria M, Bijl RV, Lin E, Walters EE, Kessler RC. Income differences in persons seeking outpatient treatment for mental disorders: a comparison of the United States with Ontario and the Netherlands. Arch Gen Psychiatry. 2000;57:383–391. doi: 10.1001/archpsyc.57.4.383. - DOI - PubMed
    1. Dalstra JA, Kunst AE, Borrell C, Breeze E, Cambois E, Costa G, Geurts JJ, Lahelma E, Van Oyen H, Rasmussen NK, Regidor E, Spadea T, Mackenbach JP. Socioeconomic differences in the prevalence of common chronic diseases: an overview of eight European countries. Int J Epidemiol. 2005;34:316–326. doi: 10.1093/ije/dyh386. - DOI - PubMed
    1. Lorant V, Deliege D, Eaton W, Robert A, Philippot P, Ansseau M. Socioeconomic inequalities in depression: a meta-analysis. Am J Epidemiol. 2003;157:98–112. doi: 10.1093/aje/kwf182. - DOI - PubMed
    1. Weich S, Lewis G. Poverty, unemployment, and common mental disorders: population based cohort study. BMJ. 1998;317:115–119. doi: 10.1136/bmj.317.7151.115. - DOI - PMC - PubMed

Publication types

LinkOut - more resources