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National context of healthcare, economy and religion, and the association between disability and depressive symptoms in older Europeans: results from the EURODEP concerted action

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Abstract

Associations between disability and depression have been shown to be consistent across cultures among middle-aged adults. In later life the association between disability and depression is much more substantial and may be amenable to influences by health care facilities as well as economic and sociocultural factors. Fourteen community-based studies on depression in later life in 11 western European countries contribute to a total study sample of 22,570 respondents aged 65 years or older. Measures are harmonised for depressive symptoms (EURO-D scale) and disability. Using multilevel modelling to control for the stratified data structure we examined whether the association between disability and depressive symptoms is modified by national health care and mental health care availability, national economic circumstances, demographic characteristics and religious tradition. The association between depressive symptoms and disability is attenuated by health care expenditure and availability of mental health care and also by gross domestic product; it was more pronounced in countries with high levels of orthodox religious beliefs. Higher levels of depressive symptoms are found in countries with a larger gross domestic product (per capita) and higher health care expenses but are interpreted with care because of measurement differences between the centres. The findings from this contextual perspective indicate that general and mental health care should be geared to one another wherever possible.

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Acknowledgements

The EURODEP collaboration was supported by the European Commission BIOMED 1 initiative. The current study was supported by a grant from the Universitair Stimuleringsfonds of the Vrije Universiteit Amsterdam.

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Authors and Affiliations

  1. Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands

    Arjan W. Braam

  2. Department of Psychiatry and Institute for Research of Extramural Medicine, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

    Arjan W. Braam, Aartjan T. F. Beekman, Dorly J. H. Deeg & Robert A. Schoevers

  3. Department of Psychiatry/Neuropsychology, Social Psychiatry and Psychiatric Epidemiology, University of Maastricht, Maastricht, The Netherlands

    Philippe Delespaul

  4. Institut National de la Santé et de la Recherche Médicale U593, Université Victor Segalen, Bordeaux, France

    Karine Pérès

  5. Institute of Psychiatry, Department of Epidemiology, King’s College, University of London, London, UK

    Michael Dewey & Martin J. Prince

  6. Department of General Practice, University of Turku, Turku, Finland

    Sirkka-Liisa Kivelä

  7. Unit of General Practice, Turku University Hospital, Satakunta Central Hospital, Turku, Finland

    Sirkka-Liisa Kivelä

  8. Department of Psychiatry, Jonathan Swift Clinic, St. James’ Hospital, Dublin, Ireland

    Brian A. Lawlor

  9. Heilsugaeslustö Grundarfirði, Iceland

    Hallgrímur Magnússon

  10. Department of Psychiatry, Ludwigs-Maximilian-Universität, Munich, Germany

    Ingeborg Meller

  11. Psychiatrische Klinik und Poliklinik, Freie Universität Berlin, Berlin, Germany

    Friedel M. Reischies

  12. Vakgroep Experimenteel-klinische en gezondheidspsychologie, Universiteit Gent, Ghent, Belgium

    Marc Roelands

  13. Servicio de Psicomática, Universidad de Zaragoza, Zaragoza, Spain

    Pedro Saz

  14. Institute of Clinical Neurosciences, Sahlgrenska University Hospital, Gothenburg University, Gothenburg, Sweden

    Ingmar Skoog

  15. Dipartimento Materno Infantile, Facoltà di Medicina, Università degli studi di Brescia, Brescia, Italy

    Cesare Turrina

  16. Afdeling Epidemiologie, Wetenschappelijk Instituut Volksgezondheid, Brussels, Belgium

    Ann Versporten

  17. Section of Old Age Psychiatry, Department of Psychiatry, University of Liverpool, Liverpool, UK

    John R. M. Copeland

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  1. Arjan W. Braam
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  2. Philippe Delespaul
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  3. Aartjan T. F. Beekman
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  6. Michael Dewey
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  7. Sirkka-Liisa Kivelä
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  8. Brian A. Lawlor
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  9. Hallgrímur Magnússon
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  10. Ingeborg Meller
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  11. Martin J. Prince
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  12. Friedel M. Reischies
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  13. Marc Roelands
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  14. Pedro Saz
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  15. Robert A. Schoevers
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  16. Ingmar Skoog
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  17. Cesare Turrina
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  18. Ann Versporten
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  19. John R. M. Copeland
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Correspondence to Arjan W. Braam.

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Braam, A.W., Delespaul, P., Beekman, A.T.F. et al. National context of healthcare, economy and religion, and the association between disability and depressive symptoms in older Europeans: results from the EURODEP concerted action. Eur J Ageing 1, 26–36 (2004). https://doi.org/10.1007/s10433-004-0013-2

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