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


OBJECTIVE
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.


METHODS
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.
Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Oakfield House, Oakfield Grove, Clifton, Bristol BS8 2BN, UK. dheeraj.rai@bristol.ac.uk
Dheeraj
D
Rai
Pedro
P
Zitko
Kelvyn
K
Jones
John
J
Lynch
Ricardo
R
Araya
D003431:Cross-Cultural Comparison; D003863:Depression / Q000191:economics* / Q000453:epidemiology*; D005260:Female; D014943:Global Health / Q000191:economics / Q000706:statistics & numerical data*; D054624:Health Status Disparities; D006306:Health Surveys / Q000706:statistics & numerical data; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D007406:Interview, Psychological; D008297:Male; D055361:Multilevel Analysis; D016017:Odds Ratio; D015995:Prevalence; D017678:Sex Distribution; D012959:Socioeconomic Factors; D014944:World Health Organization