Gender differences in the prevalence of mental distress in East and West Germany over time: a hierarchical age-period-cohort analysis, 2006–2021

Abstract

Purpose Mental distress has become a major public health concern. Temporal trends in psychological distress are complex and depend on numerous factors. In this study, we examined age-period-cohort effects for mental distress including gender and German region over a 15 years’ time span. Methods Data on mental distress from ten cross-sectional surveys of the general German population, covering the years from 2006 to 2021, was used. Hierarchical age-period-cohort analyses including gender and German region as predictors were performed to disentangle age, period, and cohort effects. The Patient Health Questionnaire-4 was used as a brief screener for mental distress. Results We found significant period and cohort effects, with peek values for mental distress in the years 2017 and 2020 and for the oldest birth cohort (born before 1946). Age did not affect mental distress when cohort- and period effects as well as gender and German region were considered. An interaction effect for gender and the German region was found. Women in West Germany reported significantly higher mental distress compared to women in East Germany. Compared to men, women reported the highest prevalence in both regions. Conclusion Important political events as well as major crises can lead to an increase of mental distress in societies. Furthermore, an association between birth cohort and mental distress could be linked to socialization effects of that certain time, causing traumatic experiences or a specific coping style within this cohort group. Prevention and intervention strategies could benefit from acknowledging structural differences linked to period and cohort effects.

The Brief Symptom Inventory in the Swiss general population: Presentation of norm scores and predictors of psychological distress

“…Similarly, younger participants, those with compulsory schooling only and unemployed participate reported higher distress and were more likely to reach potentially clinical levels of distress (caseness) [ 2 , 22 , 52 , 53 ]. While the effect of age might be explained by cognitive and emotional development but also differences in developmental tasks which are predominant in adolescence and young adulthood [ 54 ], others have found that a cohort effect related to political or global events might be important [ 55 ]. Regarding socio-economic characteristics, there is evidence based on a systematic review and meta-analyses that they influence psychological distress on various levels, such as experienced stress on the individual level or social comparisons on the neighborhood level [ 56 ].…”