Abstract
Low objective socioeconomic status (SES) has been correlated with poor physical and mental health among older adults. Some studies suggest that subjective SES is also important for ensuring sound physical and mental health among older adults. However, few studies have been conducted on the impact of both objective and subjective SES on mental health among older adults. This study examines whether objective or subjective SES is associated with depressive symptoms in older adults in Myanmar. This cross-sectional study, conducted between September and December, 2018, used a multistage sampling method to recruit participants from two regions of Myanmar, for face-to-face interviews. The Geriatric Depression Scale (GDS) was used to evaluate the depressive symptoms. Participants were classified as having no depressive symptom (GDS score <5) and having depressive symptoms (GDS score ≥5). Objective and subjective SES were assessed using the wealth index and asking participants a multiple-choice question about their current financial situation, respectively. The relationship between objective/subjective SES and depressive symptoms was examined using a multivariable logistic regression analysis. The mean age of the 1,186 participants aged 60 years and above was 69.7 (SD: 7.3), and 706 (59.5%) were female. Among them, 265 (22.3%) had depressive symptoms. After adjusting for objective SES and other covariates, only low subjective SES was positively associated with depressive symptoms (adjusted odds ratio, AOR: 4.18, 95% confidence interval, CI: 2.98-5.87). This association was stronger among participants in the rural areas (urban areas, AOR: 2.10, 95% CI: 1.08-4.05; rural areas, AOR: 5.65, 95% CI: 3.69-8.64). Subjective SES has a stronger association with depressive symptoms than objective SES, among older adults of the two regions in Myanmar, especially in the rural areas. Interventions for depression in older adults should consider regional differences in the context of subjective SES by reducing socioeconomic disparities among the communities.
Highlights
Objective socioeconomic status (SES) is defined as the economic and social position such as working status, household wealth, and poverty status [1,2,3,4]
The main contribution of this study was the identification of the associations between depressive symptoms and objective and subjective SES in older adults living in low-income settings in Myanmar, where the aging trend in population is expected to increase rapidly
Previous studies in middle- or high-income countries only observed a significant association between objective SES and mental health [5, 6, 9]
Summary
Objective socioeconomic status (SES) is defined as the economic and social position such as working status, household wealth, and poverty status [1,2,3,4]. In a literature review on subjective SES and health, lower subjective SES was associated with significantly increased odds of non-communicable diseases, with a trend toward increased odds of obesity [13] It suggested that the perception of one’s own status in a social hierarchy has effects on one’s health. This is in line with studies of Japanese older adults, whose subjective ratings of SES predict poor subjective mental health at a similar level of objective SES indicators [11]. Both objective and subjective SES are hypothesized to indicate the most significant disparities, such that individuals with lower SES tend to have poor physical and psychological health This relationship does not seem to reflect the effects of poverty [19]. Evidence of the association between SES (measured in various forms) and health has been interpreted as evidence that social stratification, not objective socioeconomic resources, have a meaningful impact on physical health [19, 20]
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