Abstract
RationaleTwo gaps in the literature arise on the relationship between social cohesion and depressive disorders. Firstly, there is a lack of studies comparing countries with diverse communal bonds and population-level differences in depression. Secondly, most work on explanatory mechanisms has overwhelmingly focussed on social network and social support pathways. ObjectivesWe compared the prospective association between perceived neighbourhood social cohesion and depressive symptoms among older adults in England, the Czech Republic, Poland and Russia; and examined whether psychological and health behavioural pathways mediated this association. MethodsHarmonized data on 26,081 adults from the English Longitudinal Study of Ageing (ELSA), and the Health, Alcohol and Psychosocial factors In Eastern Europe (HAPIEE) studies were analysed. Prospective associations between perceived neighbourhood social cohesion at baseline and depressive symptoms at follow-up were assessed using multivariable negative binomial regression. The psychological (through control of life, and control at home) and health behavioural (through smoking and drinking) pathways were tested using path analysis. ResultsLow cohesion predicted a higher number of depressive symptoms at follow-up among English (b = 0.106, p = 0.001), Czech (b=0.203, p < 0.001), Polish (0.115, p < 0.001) and Russian adults (b = 0.087, p < 0.001). Indirect effects via psychological mechanisms were strong and explained 64% (Poland), 82% (Russia), 84% (England) and 95% (Czech Republic) of the total indirect effects from low cohesion to elevated symptoms in these populations. Indirect effects via health behaviours were much weaker by comparison. ConclusionsProspective associations between low social cohesion and increased depressive symptoms were largely congruent among older adults from England and three Central and Eastern European countries. These associations operated via a psychological, but not a health behavioural, pathway among ageing adults living in diverse parts of Europe.
Highlights
Adults face a greater incidence of depressive disorders in later life; due to the onset of less severe forms of depression, such as dysthymia, minor depression and unspecified depressive disorder (Haigh et al., 2018)
Country differences in social cohesion possess a striking similarity to country differences in depressive symptomatology, as social cohesion levels are noticeably lower in Central/Eastern and Southern countries than elsewhere in Europe (Anderson and Unzicker, 2014; Kääriäinen and Lehtonen, 2006; Poortinga, 2006)
Items on interpersonal trust and help from neighbours were worded as follows: i) ‘Most people in this area can't be trusted’/‘Most people in this area can be trusted,’ and ‘Is there trust among people in your area of residence?’ and ii) ‘If you were in trouble, there is nobody in this area who would help you’/‘If you were in trouble, there are lots of people in this area who would help you,’ and ‘Would your neighbours help you if you needed it?’ respectively in English Longitudinal Study of Ageing (ELSA) and HAPIEE
Summary
Adults face a greater incidence of depressive disorders in later life; due to the onset of less severe forms of depression, such as dysthymia, minor depression and unspecified depressive disorder (Haigh et al., 2018). Cross-national studies suggest that depressive symptomatology is more pervasive among older adults living in Central/Eastern and Southern countries than North-western European countries (CastroCosta et al, 2007; Kok et al, 2012) These country differences emphasize macro-level determinants that may trigger proximal causes of depressive disorders; such as the upstream influence of social cohesion (De Silva et al, 2005; Ehsan and De Silva, 2015; Julien et al, 2012). Country differences in social cohesion possess a striking similarity to country differences in depressive symptomatology, as social cohesion levels are noticeably lower in Central/Eastern and Southern countries than elsewhere in Europe (Anderson and Unzicker, 2014; Kääriäinen and Lehtonen, 2006; Poortinga, 2006). Given this clustering within particular European countries, cross-cultural work that compares the association between social cohesion and depressive symptomatology in countries with dissimilar population-level distributions are valuable (Berkman et al, 2000)
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