Abstract
Increasing educational attainment (EA) could decrease the occurrence of depression. We investigated the relationship between EA and depressive symptoms in older individuals across four European regions. We studied 108,315 Europeans (54% women, median age 63years old) from the Survey on Health, Ageing and Retirement in Europe assessing EA (seven educational levels based on International Standard Classification of Education [ISCED] classification) and depressive symptoms (≥4 points on EURO-D scale). Logistic regression estimated the association between EA and depressive symptoms, adjusting for sociodemographic and health-related factors, testing for sex/age/region and education interactions. Higher EA was associated with lower odds of depressive symptoms, independent of sociodemographic and health-related factors. A threshold of the lowest odds of depressive symptoms was detected at the first stage of tertiary education (OR 0.60; 95% confidence interval [CI] 0.55-0.65; p<0.001; relative to no education). Central and Eastern Europe showed the strongest association (OR for high vs. low education 0.37; 95% CI 0.33-0.40; p<0.001) and Scandinavia the weakest (OR for high vs. low education 0.69; 95% CI 0.60-0.80; p<0.001). The association was strongest among younger individuals. There was a sex and education interaction only within Central and Eastern Europe. Level of EA is reflected in later-life depressive symptoms, suggesting that supporting individuals in achieving EA, and considering those with lower EA at increased risk for depression, could lead to decreased burden of depression across the life course. Further educational support in Central and Eastern Europe may decrease the higher burden of depressive symptoms in women.
Highlights
The World Health Organization ranked depression as the third largest burden of disease globally, expecting it to rank first by 2030 [1]
From the 139,556 individuals who completed at least one interview in SHARE, we excluded those with missing data on depressive symptoms (n = 22,247) and educational attainment (EA) (n = 1,299), individuals younger than 50 years (n = 4,233) and participants from Israel (n = 3,462), as this study focused on older European population, leaving the sample of 108,315 persons from four European regions: Western Europe (n = 44,094), Central and Eastern Europe (CEE) (n = 28,611), Southern Europe (n = 23,944), and Scandinavia (n = 11,666), see Supplemental Figure S1
Sensitivity analysis with a higher cut-off for depressive symptoms did not change the results to a great extent (Supplemental Table S1). In this large population-based cohort study of more than 100,000 individuals residing in 20 diverse countries across four European regions, we observed a lower burden of depressive symptoms associated with higher EA; the first stage of tertiary education was a threshold for the benefits of EA, with no apparent protective effect against depressive symptoms observed beyond this level
Summary
The World Health Organization ranked depression as the third largest burden of disease globally, expecting it to rank first by 2030 [1]. Risks for depression include social, economic, geographic, and biological factors, which are reflected through inequitable distribution of depression across European subpopulations, with the highest burden in women, less educated individuals with fewer socioeconomic resources, and within Southern and Central and Eastern Europe (CEE) [2–5]. These discrepancies indicate that reduction of these inequalities could result in diminished risk for depression in Europe. EA has more recently been identified as a strong predictor of adult health and longevity, within the US [9,15,16] and several European countries [17,18] It is widely discussed whether the association between EA and depression is causal or explained by other sociodemographic or health-related factors [19–21]. Further educational support in Central and Eastern Europe may decrease the higher burden of depressive symptoms in women
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
