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A longitudinal comparison of depression in later life in the US
and EnglandBram Vanhoutte, Stephen Jivraj & James Nazroo
Centre for Survey and Census Research, University of Manchester
XI ISQOLS conferenceVenice, Italy
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Introduction
• Why study depression …
– … in later life?
– … longitudinally?
– … comparatively?
Sorrowing old man, Vincent Van Gogh, 1890
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Departing from two findings
• More depression among women than men (Piccinelli & Wilkinson 2000)
• More depression in England than US (Weissman et al 1996, Zivin et al 2010)
England US0
0.20.40.60.8
11.21.41.61.8
2
MaleFemale
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Possible explanations
1. Measurement instrument functions differently?
2. Difference in associations between social factors and depressive symptoms?
3. Background context effects?
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Theoretical expectations
• Depression is not a monolithic disease, but an emotional disorder accompanied by physiological symptoms… -> Mood (feeling sad, not enjoying life, … ) -> Somatic symptoms (tiredness, sleep problems, …)
• Somatic symptoms not unique to depression, but also related to chronic illnesses, cognitive impairment, general stresses of later life (Parmelee, 2007)
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1. Measurement• Multiple Group Confirmatory Factor Analysis
(MGCFA)• … CFA?
– A ‘theory-driven’ way to measure latent concepts through observed indicators
• Theory-driven because the relations are specified before doing analysis
• Latent concepts -> values / diseases• Observed indicators -> items / symptoms / …
• … Multiple group?– Because we want to investigate the latent concept in several groups
(countries/gender), and want to see if the structure between indicators and concept is the same in the different groups
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Centre for Epidemiological Studies Depression scale (CESD)
• (Much of the time during past week),– You felt depressed?– You felt that everything you did was an effort?– Your sleep was restless– You were happy– You felt lonely– You enjoyed life– You felt sad– You could not get going
• Answer with Yes/No
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Reminder: Parameters in CFA
ITEM
LATENTCONCEPT
FACTORLOADING
ERROR
ERROR CORRELATION
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Results MGCFA (wlmsv estimation on 2002 ELSA/HRS data)
Whole sample RMSEA CFI
CES-D scale (1 factor) .075 .965
Mood and Somatic factor (2 factors) .052 .984
By country and gender (4 groups) 2 factor model (Mood & Somatic)
RMSEA CFI
Configural invariance .055 .982
Metric invariance .056 .977
Scalar invariance .056 .977
Note: Fit indices RMSEA: good fit if <.06CFI good fit if >.95
(Hu & Bentler 1999)
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Results Measurement
-> Depression is best measured using 2 seperate scales, one for mood and one for somatic symptoms
-> Scales are equivalent over gender and country
-> Differences between countries and genders are not due to differential functioning of scale items
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2. Differential associations
• Method: – Panel-data : multiple observations for each person– > Multilevel growth model to account for changes
over time within individuals
• We do not want to impose a threshold on the number of symptoms needed to be categorised as depressed– > Count data instead of categorical approach
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Mood Symptoms
0.2
.4.6
.8P
rop
ortio
n
0 1 2 3 4 5k
observed proportion neg binom probpoisson prob
mean = .7046; overdispersion = 2.546
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Somatic Symptoms0
.1.2
.3.4
.5P
rop
ortio
n
0 1 2 3k
observed proportion neg binom probpoisson prob
mean = .7778; overdispersion = .3677
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What’s comparable?
• ‘Ethnicity’• Employment status • Marital status• Education• Wealth• Limitations in activities of daily living
– > + interactions with gender/wave/country
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Mood symptoms over age
55 58 61 64 67 70 73 76 79 82 85 88 91 94 970.5
0.7
0.9
1.1
1.3
1.5
1.7
England
US
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Somatic Symptoms over age by country
55 58 61 64 67 70 73 76 79 82 85 88 91 94 970.600000000000001
0.700000000000001
0.800000000000001
0.900000000000001
1
1.1
1.2
1.3
1.4
US
England
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Ethnic differences in mood symptoms
England US0
0.2
0.4
0.6
0.8
1
1.2
1.4
white ethnic backgroundother ethnic background
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Partner status and mood symptoms
England men England women
US men US women0
0.2
0.4
0.6
0.8
1
1.2
1.4
CoupleSingleSeperatedWidowed
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Wealth gradient in mood
1 2 3 4 5 6 7 8 9 100
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
EnglandUS
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Educational differences in somatic symptoms
low education middle education higher education0
0.2
0.4
0.6
0.8
1
1.2
ELSAHRS
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Somatic symptoms and adl
0 1 2 3 4 5 6 7 8 9 10 110
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
2
ELSA MaleELSA femaleHRS maleHRS female
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Conclusion: Measurement
• CESD has very good properties to be used for comparative studies
• In later life, it makes sense to distinguish mood symptoms from somatic symptoms– Mood more influenced by partnership status
(especially for men)– Somatic symptoms more related to educational
differences and limitations in ADL -> might not be clinical depression
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Conclusion: Differential effects
• Being non-white or having a degree more associated with depressed mood in England compared to US
• Being single or having limitations in ADL gives higher chance for depressive symptoms in US
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Conclusion: Background effects?
• The strongest sex: a construction of masculinity?– Suicide rates among men about 4 times higher– Coping works quite different between genders
• Psychotherapy culture in the USA:– Role of prior depression and treatment