Gender differential in social and economic predictors of incident major depressive disorder in the Ibadan Study of Ageing

Abstract

PurposeWorking on the hypothesis that the social and economic factors associated with onset of late-life depression operate differently for men and women, we investigated the impact of current social relationships and lifetime occupational attainment on incident major depressive disorder (MDD) assessed in three follow-up waves over a period of 5 years.MethodsParticipants were part of a household multistage probability sample of 2149 Nigerians who were aged 65 years and above. The presence of current and lifetime MDD was assessed using the World Health Organization (WHO) Composite International Diagnostic Interview. Participants’ highest occupational attainment was categorised based on the International Standard Classification of Occupations, while socio-economic positions were estimated using asset-based measures relevant to low-income settings. Current social contacts and participation were assessed using items from the WHO Disability Assessment Schedule.ResultsWe found an incidence rate of 120.9 per 1000 persons years (95% CI = 110.4–132.5) among 1394 persons who were free of lifetime MDD and dementia at baseline. Incidence rates were 94.7 (95% CI = 82.5–108.7) and 153.8 (136.3–173.6) per 1000 person years, in men and women respectively. In analyses comparing gender and adjusting for the effect of age, we found that while a lifetime of unskilled occupation (trade: HR = 1.4, 95% CI = 1.0–2.0, and elementary occupations: HR = 1.5, 95% CI = 1.1–2.1) was significantly associated with incident MDD in men (but not in women), living in a rural location (HR = 1.3, 95% CI = 1.0–1.7) and having no regular contact with family (HR = 2.2, 95% CI = 1.0–4.7) at baseline significantly predicted subsequent onset of MDD in women.ConclusionThere was a gender differential in the association of social and economic factors with incident MDD in this sample. These findings have implications for the design of early prevention strategies for late-life depression in sub-Saharan Africa.Electronic supplementary materialThe online version of this article (10.1007/s00127-018-1500-7) contains supplementary material, which is available to authorized users.

The roles of depression and social relationships in the onset and course of loneliness amongst Nigerian elders

“…16 Such relationship is yet to be examined in LMICs. Third, in a series of studies by our group, 17,18 we found some of the highest global prevalence and incidence rates of late-life depression among Nigerian older persons. The extent to which the high rates of late-life depression impacts on onset, chronicity, or recovery from loneliness in people living in SSA is unknown.…”

Late-life depression in sub-Saharan Africa: lessons from the Ibadan Study of Ageing

“…The mean number of lifetime episodes was approximately two. When assessed in three follow-up waves over a period of 5 years (Ojagbemi et al, 2018b), the incidence rate of MDD of 120.9 per 1000 person years (95% CI 110.4-132.5) was found among 1394 persons who were free of lifetime MDD and dementia at baseline. Incidence rates were 94.7 (95% CI 82.5-108.7) and 153.8 (95% CI 136.3-173.6) per 1000 person years in men and women, respectively (Ojagbemi et al, 2018b).…”

“…For example, prevalent MDD was associated with poor social engagement (Ojagbemi and Gureje, 2019 a ), loneliness (Ojagbemi and Gureje, 2019 a ) and increasing level of urbanisation in the place of residence (Gureje et al ., 2007) with odds ratios (OR) of 3.1, 2.3 and 1.4, respectively. Overall, poor social network was a key modifiable risk factor for incident MDD (Gureje et al ., 2011; Ojagbemi et al ., 2018 b ). Specifically, living in a rural location and having no regular contact with family (both of which can be regarded as indicators of poor social network) at baseline were associated with subsequent onset of MDD (Gureje et al ., 2011; Ojagbemi et al ., 2018 b ).…”

“…Overall, poor social network was a key modifiable risk factor for incident MDD (Gureje et al ., 2011; Ojagbemi et al ., 2018 b ). Specifically, living in a rural location and having no regular contact with family (both of which can be regarded as indicators of poor social network) at baseline were associated with subsequent onset of MDD (Gureje et al ., 2011; Ojagbemi et al ., 2018 b ). One plausible interpretation of this finding is that the migration of younger family members to areas with better economic opportunities may be reducing the social network of elderly persons living in affected communities.…”

“…The well-known relationship between low economic position and late-life depression in HICs (Goncalves-Pereira et al ., 2019) was not replicated in the ISA with the use of asset-based measurement of economic status, a commonly used indicator of wealth in low-income settings (Ferguson et al ., 2003). Nevertheless, incident MDD was associated with a lifetime of unskilled occupation in men (Ojagbemi et al ., 2018 b ). Perhaps, this finding suggests that composite indices of economic position such as lifetime occupational attainment, which embraces education, longer term income, social status and potential for asset acquisition over-time, may be more stable and sensitive to capture longer term economic effect of late-life depression in SSA and other LMIC settings.…”