Socioeconomic inequalities in impairment associated with depressive symptoms: Evidence from the National Survey on Drug Use and Health

Regina García-Velázquez; Kaisla Komulainen; Kia Gluschkoff; Jaakko Airaksinen; Ilmari Määttänen; Tom Henrik Rosenström; Markus Jokela

doi:10.1016/j.jpsychires.2021.06.029

Socioeconomic inequalities in impairment associated with depressive symptoms: Evidence from the National Survey on Drug Use and Health

J Psychiatr Res. 2021 Sep:141:74-80. doi: 10.1016/j.jpsychires.2021.06.029. Epub 2021 Jun 21.

Authors

Regina García-Velázquez¹, Kaisla Komulainen², Kia Gluschkoff³, Jaakko Airaksinen⁴, Ilmari Määttänen², Tom Henrik Rosenström², Markus Jokela²

Affiliations

¹ Department of Psychology and Logopedics, University of Helsinki, Finland; Finnish National Institute for Health and Welfare, Helsinki, Finland. Electronic address: regina.garcia.velazquez@thl.fi.
² Department of Psychology and Logopedics, University of Helsinki, Finland.
³ Department of Psychology and Logopedics, University of Helsinki, Finland; Finnish National Institute for Health and Welfare, Helsinki, Finland.
⁴ Department of Psychology and Logopedics, University of Helsinki, Finland; Institute of Criminology and Legal Policy, University of Helsinki, Finland.

PMID: 34175745
DOI: 10.1016/j.jpsychires.2021.06.029

Abstract

Objective: Individuals with low socioeconomic status have higher rates of depression, but it is unknown whether the socioeconomically disadvantaged also have more disabling depressive symptoms. We examined (1) the associations of three indicators of socioeconomic status with depression-related severe role impairment, and (2) whether socioeconomic factors moderate the association between individual depression symptoms and depression-related severe role impairment.

Methods: We used data from the National Survey on Drug Use and Health (NSDUH). Depressive symptoms, role impairment and socioeconomic indicators (poverty, participation in workforce, educational attainment) were self-reported by participants. The analytic sample consisted of participants who screened positive for a depressive episode during past 12 months (n = 32 661). We used survey-weighted logistic models to examine the associations of depressive symptoms with severe role impairment and the modifying effects of socioeconomic indicators.

Results: The association between depression symptom count and severe role impairment was stronger among those not in workforce (OR = 1.12[1.02-1.23]). The association between specific depression symptoms and severe role impairment was stronger for conditions of poverty (fatigue, OR = 2.97 [1.54-5.73]; and anhedonia, OR = 1.93[1.13-3.30]), workforce non-participation (inability to concentrate/indecisiveness, OR = 1.54[1.12-2.12]), and lower educational attainment (anhedonia, OR = 0.77 [0.59-0.99]). Feelings of worthlessness was the only symptom with independent associations for all socioeconomic groups (adjusted OR = 1.91[1.35-2.70]).

Conclusion: Depression was more frequent and also more disabling for socioeconomically disadvantaged groups, especially when assessed with workforce participation. Additionally, some specific symptoms showed socioeconomic differences. Our findings highlight the need to prioritize population groups with more severe impairment associated with depressive symptoms.

Keywords: Depression; Epidemiology; Impairment; Socioeconomic.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Depression* / epidemiology
Health Surveys
Humans
Pharmaceutical Preparations*
Poverty
Socioeconomic Factors

Substances

Pharmaceutical Preparations