Social Psychiatry and Psychiatric Epidemiology

, Volume 48, Issue 12, pp 1931–1939 | Cite as

Multidimensional health locus of control and depressive symptoms in the multi-ethnic population of the Netherlands

  • Tobias K. van Dijk
  • Henriëtte Dijkshoorn
  • Ad van Dijk
  • Stephan Cremer
  • Charles Agyemang
Original Paper



Ethnic inequalities in health in Western societies are well-documented but poorly understood. We examined associations between health locus of control (HLC) and depressive symptoms among native and non-native Dutch people in the Netherlands.


We used hierarchical multiple linear regression analyses on a representative sample of the multi-ethnic population of Amsterdam and The Hague (n = 10,302). HLC was measured with the multidimensional health locus of control scale. Depressive symptoms were measured with the Kessler Psychological Distress scale.


Multivariate analyses showed that HLC contributes to ethnic differences in the prevalence of depressive symptoms. Respondents who scored high on external locus of control (PHLC) were more likely to have depressive symptoms than those with a low score on PHLC (β = 0.133, p < 0.001). Conversely, respondents scoring high on internal locus of control (IHLC) were less likely to have depressive symptoms compared to those scoring low on IHLC (β = −0.134, p < 0.001). The associations were most pronounced among Turkish-Dutch and Moroccan-Dutch respondents.


Our findings suggest that HLC contributes to ethnic inequalities in depressive symptoms, especially among Turkish and Moroccan ethnic groups. Professionals (e.g. clinicians and policy makers) need to take HLC into account when assessing and treating depression among ethnic minority groups, particularly in Turkish and Moroccan populations. Future research should look further into the associations within these groups.


Depression Locus of control Ethnic minorities Cultural comparison 



We would like to thank Academic Collaboration of the Municipal Health Service Amsterdam and the Academic Medical Center Amsterdam for funding this study. S. Cremer and H. Dijkshoorn conceived the idea. T.K. van Dijk was responsible for data analysis and writing the article. All co-authors contributed to the conceptualization, writing, and review of drafts of the article.

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical standard

This study has been approved by the Medical Ethical Commission of the Academic Medical Center Amsterdam, the Netherlands.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Tobias K. van Dijk
    • 1
  • Henriëtte Dijkshoorn
    • 1
  • Ad van Dijk
    • 2
  • Stephan Cremer
    • 1
  • Charles Agyemang
    • 3
  1. 1.Department of Epidemiology, Documentation, and Health PromotionMunicipal Health Service Amsterdam (GGD)AmsterdamThe Netherlands
  2. 2.Department of Epidemiology, Social Care, and Health PromotionMunicipal Health Service (GGD)The HagueThe Netherlands
  3. 3.Department of Social Medicine, Amsterdam Medical CentreUniversity of AmsterdamAmsterdamThe Netherlands

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