Kok Renske, Avendano Mauricio, Bago d'Uva Teresa, Mackenbach Johan
Soc Indic Res. 2012 Jan;105(2):191-210. doi: 10.1007/s11205-011-9877-7. Epub 2011 Jun 15.
Depression is one of the leading causes of disability in the developed world. Previous studies have shown varying depression prevalence rates between European countries, and also within countries, between socioeconomic groups. However, it is unclear whether these differences reflect true variations in prevalence or whether they are attributable to systematic differences in reporting styles (reporting heterogeneity) between countries and socioeconomic groups. In this study, we examine the prevalence of three depressive symptoms (mood, sleeping and concentration problems) and their association with educational level in 10 European countries, and examine whether these differences can be explained by differences in reporting styles. We use data from the first and second waves of the COMPARE study, comprising a sub-sample of 9,409 adults aged 50 and over in 10 European countries covered by the Survey of Health, Ageing and Retirement in Europe. We first use ordered probit models to estimate differences in the prevalence of self-reported depressive symptoms by country and education. We then use hierarchical ordered probit models to assess differences controlling for reporting heterogeneity. We find that depressive symptoms are most prevalent in Mediterranean and Eastern European countries, whereas Sweden and Denmark have the lowest prevalence. Lower educational level is associated with higher prevalence of depressive symptoms in all European regions, but this association is weaker in Northern European countries, and strong in Eastern European countries. Reporting heterogeneity does not explain these cross-national differences. Likewise, differences in depressive symptoms by educational level remain and in some regions increase after controlling for reporting heterogeneity. Our findings suggest that variations in depressive symptoms in Europe are not attributable to differences in reporting styles, but are instead likely to result from variations in the causes of depressive symptoms between countries and educational groups.
抑郁症是发达国家导致残疾的主要原因之一。先前的研究表明,欧洲国家之间以及国家内部不同社会经济群体的抑郁症患病率各不相同。然而,尚不清楚这些差异是反映了患病率的真实变化,还是归因于不同国家和社会经济群体在报告方式上的系统差异(报告异质性)。在本研究中,我们调查了10个欧洲国家中三种抑郁症状(情绪、睡眠和注意力问题)的患病率及其与教育水平的关联,并研究这些差异是否可以用报告方式的不同来解释。我们使用了COMPARE研究第一波和第二波的数据,该研究包括欧洲健康、老龄化和退休调查覆盖的10个欧洲国家中9409名50岁及以上成年人的子样本。我们首先使用有序概率模型来估计按国家和教育程度划分的自我报告抑郁症状患病率的差异。然后,我们使用分层有序概率模型来评估控制报告异质性后的差异。我们发现,抑郁症状在地中海和东欧国家最为普遍,而瑞典和丹麦的患病率最低。在所有欧洲地区,较低的教育水平与较高的抑郁症状患病率相关,但这种关联在北欧国家较弱,而在东欧国家较强。报告异质性并不能解释这些跨国差异。同样,在控制报告异质性后,抑郁症状在教育水平上的差异仍然存在,并且在某些地区有所增加。我们的研究结果表明,欧洲抑郁症状的差异并非归因于报告方式的不同,而是可能源于不同国家和教育群体中抑郁症状成因的差异。