Inequalities in elevated depressive symptoms in middle‐aged and older adults by rural childhood residence: The important role of education

Abstract

Objectives To quantify inequalities in the prevalence of elevated depressive symptoms by rural childhood residence and the extent to which childhood socioeconomic conditions and educational attainment contribute to this disparity. Methods We identified the prevalence of depressive symptoms among US‐born adults ages 50 years and older in the 1998 to 2014 waves of the Health and Retirement Study (n = 16 022). We compared prevalence of elevated depressive symptoms (>4/8 symptoms) by rural versus nonrural childhood residence (self‐report) and the extent to which own education mediated this disparity. We used generalized estimating equations and marginal standardization to calculate predicted probabilities of elevated depressive symptoms. Results In age, race/ethnicity, and sex‐adjusted models, rural childhood residence was associated with elevated depressive symptoms (OR = 1.20; 95% CI, 1.12‐1.29; marginal predicted probability 10.5% for rural and 8.9% for nonrural childhood residence). Adjusting for US Census birth region and parental education attenuated this association (OR = 1.07; 95% CI, 0.99‐1.15; marginal predicted probability 9.9% for rural and 9.3% for nonrural). After additional adjustment for own education, rural childhood residence was not associated with elevated depressive symptoms (OR = 0.94; 95% CI, 0.87‐1.01; marginal predicted probability 9.2% for rural and 9.8% for nonrural). Conclusions Rural childhood residence was associated with elevated depressive symptoms in middle‐aged and older adults; birth region, parental education, and own education appear to contribute to this disparity.

Does digital technology reduce health disparity? Investigating difference of depression stemming from socioeconomic status among Chinese older adults

“…In China, education and income are robustly associated with later life depression [ 5 , 8 ]. Also, factors such as general health during childhood and parental education are highly associated with later depression [ 8 , 10 , 11 ]. Good self-rated health status during childhood [ 8 , 11 ] and a high level of parental education [ 10 , 11 ] are negatively associated with depressive symptoms.…”

“…Also, factors such as general health during childhood and parental education are highly associated with later depression [ 8 , 10 , 11 ]. Good self-rated health status during childhood [ 8 , 11 ] and a high level of parental education [ 10 , 11 ] are negatively associated with depressive symptoms. In the Chinese context, hukou (household registration) status, which is categorized into agricultural or non-agricultural, is related to the availability of a wide range of social benefits [ 31 ].…”

“…In China, the depression prevalence rates of middle-and old-aged individuals are quite high, with the overall prevalence of depression ranging from 11 to 57% among people aged over 60 years [5]. Previous studies have concluded that socioeconomic status (SES) is a strong predictor of depression [5][6][7][8][9][10][11]. Studies in the Chinese context have identified several factors strongly associated with laterlife depressive symptoms, such as education, income [5,8], hukou [9,12,13] and childhood conditions [8,11].…”

Urban and Rural Differences in Trajectories of Depressive Symptoms in Later Life in the United States

“…Another area for future research is the exploration of whether education mediates the relationship between rural residence in childhood and later life depressive symptom trajectories for women. In one study, individuals who resided in rural areas during childhood had higher depressive symptoms in mid-to-late life, and that effect was mediated by education level (Murchland et al, 2019). Living in rural areas, which tend to have lower-quality education systems, may expose individuals to low-quality education and put residents at higher risk of depressive symptoms.…”

“…Numerous previous studies have identified the influence of income and education on depression over the life course (de la Torre-Luque et al, 2019;Friedman et al, 2007;Lorant et al, 2003). Low income and education levels are unequally distributed in rural areas as compared to urban areas (Murchland et al, 2019).…”