Associations of Educational Attainment, Occupation, Social Class and Major Depressive Disorder among Han Chinese Women

Jiannong Shi ,Fengyu Yu,Gongying Li,Huaqing Meng,Guoping Huang,Guodong Miao,Jiyang Pan,Wei Zhang,Zhenming Shen,Zhengrong Liu,Tieqiao Liu,Jianhua Shen,Youhui Li,Kenneth S Kendler,Jonathan Flint,Kan Li,Chengge Gao,Yunchun Chen,Donglin Yang,Yan Zhang,Yutang Zhang,Yan Song,Yihan Li,Hong Sang,Yajuan Li,Bo Du,Min Cai,Jing Sun,Danhua Gu,Guibing Chen,Runde Pan,Ming Tao,Xueyi Wang,Xiaohong Hong,Xiang Fang,Xiaojuan Liu,Baowei Ha,Gang Wang,Kerang Zhang,Junhui Wang,Qiwen Zhang,Jinbei Zhang,Lanfen Liu,Wei Liang,Hui Zhong,Jicheng Dong,Jingfang Gao,Shugui Gao,Zhen Zhang,Xumei Wang,Tiebang Liu,Chunmei Hu,Yang Li ,Guoqing Jiang,Feihu Liu,Hong Deng,Jianguo Hu ,Xiaoping Wan ,Wei Wu ,Lixin Yang ,Qiyi Mei,Yiping Chen,Sheng Shi

doi:10.1371/journal.pone.0086674

Abstract

BackgroundThe prevalence of major depressive disorder (MDD) is higher in those with low levels of educational attainment, the unemployed and those with low social status. However the extent to which these factors cause MDD is unclear. Most of the available data comes from studies in developed countries, and these findings may not extrapolate to developing countries. Examining the relationship between MDD and socio economic status in China is likely to add to the debate because of the radical economic and social changes occurring in China over the last 30 years.Principal findingsWe report results from 3,639 Chinese women with recurrent MDD and 3,800 controls. Highly significant odds ratios (ORs) were observed between MDD and full time employment (OR = 0.36, 95% CI = 0.25–0.46, logP = 78), social status (OR = 0.83, 95% CI = 0.77–0.87, logP = 13.3) and education attainment (OR = 0.90, 95% CI = 0.86–0.90, logP = 6.8). We found a monotonic relationship between increasing age and increasing levels of educational attainment. Those with only primary school education have significantly more episodes of MDD (mean 6.5, P-value = 0.009) and have a clinically more severe disorder, while those with higher educational attainment are likely to manifest more comorbid anxiety disorders.ConclusionsIn China lower socioeconomic position is associated with increased rates of MDD, as it is elsewhere in the world. Significantly more episodes of MDD occur among those with lower educational attainment (rather than longer episodes of disease), consistent with the hypothesis that the lower socioeconomic position increases the likelihood of developing MDD. The phenomenology of MDD varies according to the degree of educational attainment: higher educational attainment not only appears to protect against MDD but alters its presentation, to a more anxious phenotype.

Highlights

One of the more robust findings in the literature describing the risk factors for psychiatric disorders concerns the association between lower socio-economic position (SEP) and higher prevalence rates of illness [1], though the nature of the relationship is believed to differ among disorders [2]
In China lower socioeconomic position is associated with increased rates of major depressive disorder (MDD), as it is elsewhere in the world
More episodes of MDD occur among those with lower educational attainment, consistent with the hypothesis that the lower socioeconomic position increases the likelihood of developing MDD

Summary

Introduction

One of the more robust findings in the literature describing the risk factors for psychiatric disorders concerns the association between lower socio-economic position (SEP) and higher prevalence rates of illness [1], though the nature of the relationship is believed to differ among disorders [2]. The findings from a seven-year follow-up of the effect of changing SEP were consistent with a causal role for low SEP: one year increases in economic hardship (financial strain, deprivation and poverty) were associated with an increase in risk of MDD [7]. The prevalence of major depressive disorder (MDD) is higher in those with low levels of educational attainment, the unemployed and those with low social status. We found a monotonic relationship between increasing age and increasing levels of educational attainment Those with only primary school education have significantly more episodes of MDD (mean 6.5, P-value = 0.009) and have a clinically more severe disorder, while those with higher educational attainment are likely to manifest more comorbid anxiety disorders

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Discussion

Conclusion