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A longitudinal comparison of depression in later life in the US and England

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Bram Vanhoutte
Bram Vanhoutte

1) The study longitudinally compares depression in older adults in the US and England using data from the ELSA and HRS surveys. 2) A confirmatory factor analysis found depression is best measured using separate mood and somatic symptom scales, and these scales function equivalently across gender and countries. 3) A multilevel growth model found relationships between social factors and depressive symptoms differ between the countries. For example, non-white ethnicity and higher education are more associated with depressed mood in England.

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A longitudinal comparison of depression in later life in the US and England Bram Vanhoutte, Stephen Jivraj & James Nazroo Centre for Survey and Census Research, University of Manchester XI ISQOLS conference Venice, Italy
Introduction Why study depression in later life? longitudinally? comparatively? Sorrowing old man, Vincent Van Gogh, 1890
Departing from two findings 2 1.5 1 Male Female 0.5 0 England US More depression among women than men (Piccinelli & Wilkinson 2000) More depression in England than US (Weissman et al 1996, Zivin et al 2010)
Possible explanations 1. Measurement instrument functions differently? 2. Difference in associations between social factors and depressive symptoms? 3. Background context effects?
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)
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
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
Reminder: Parameters in CFA LATENT CONCEPT FACTOR LOADING ITEM ERROR ERROR CORRELATION
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 <.06 CFI good fit if >.95 (Hu & Bentler 1999)
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
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
.4 .2 0 Proportion .6 .8 Mood Symptoms 0 1 2 3 4 k mean = .7046; overdispersion = 2.546 observed proportion poisson prob neg binom prob 5
.3 .2 .1 0 Proportion .4 .5 Somatic Symptoms 0 1 2 3 k mean = .7778; overdispersion = .3677 observed proportion poisson prob neg binom prob
Whats comparable? Ethnicity Employment status Marital status Education Wealth Limitations in activities of daily living > + interactions with gender/wave/country
Mood symptoms over age 1.7 1.5 1.3 1.1 England 0.9 US 0.7 0.5 55 60 65 70 75 80 85 90 95
Somatic Symptoms over age by country 1.4 1.3 1.2 1.1 England 1 0.9 0.8 US 0.7 0.6 55 60 65 70 75 80 85 90 95
Ethnic differences in mood symptoms 1.4 1.2 1 white ethnic background other ethnic background 0.8 0.6 0.4 0.2 0 England US
Partner status and mood symptoms 1.4 1.2 1 0.8 Couple 0.6 Single 0.4 Seperated Widowed 0.2 0 England men England women US men US women
Wealth gradient in mood 0.8 0.7 0.6 0.5 0.4 England 0.3 US 0.2 0.1 0 1 2 3 4 5 6 7 8 9 10
Educational differences in somatic symptoms 1.2 1 0.8 ELSA HRS 0.6 0.4 0.2 0 low education middle education higher education
Somatic symptoms and adl 2 1.8 1.6 1.4 1.2 ELSA Male 1 ELSA female 0.8 HRS male 0.6 HRS female 0.4 0.2 0 0 1 2 3 4 5 6 7 8 9 10 11
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
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
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

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A longitudinal comparison of depression in later life in the US and England

  • 1. A longitudinal comparison of depression in later life in the US and England Bram Vanhoutte, Stephen Jivraj & James Nazroo Centre for Survey and Census Research, University of Manchester XI ISQOLS conference Venice, Italy
  • 2. Introduction Why study depression in later life? longitudinally? comparatively? Sorrowing old man, Vincent Van Gogh, 1890
  • 3. Departing from two findings 2 1.5 1 Male Female 0.5 0 England US More depression among women than men (Piccinelli & Wilkinson 2000) More depression in England than US (Weissman et al 1996, Zivin et al 2010)
  • 4. Possible explanations 1. Measurement instrument functions differently? 2. Difference in associations between social factors and depressive symptoms? 3. Background context effects?
  • 5. 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)
  • 6. 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
  • 7. 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
  • 8. Reminder: Parameters in CFA LATENT CONCEPT FACTOR LOADING ITEM ERROR ERROR CORRELATION
  • 9. 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 <.06 CFI good fit if >.95 (Hu & Bentler 1999)
  • 10. 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
  • 11. 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
  • 12. .4 .2 0 Proportion .6 .8 Mood Symptoms 0 1 2 3 4 k mean = .7046; overdispersion = 2.546 observed proportion poisson prob neg binom prob 5
  • 13. .3 .2 .1 0 Proportion .4 .5 Somatic Symptoms 0 1 2 3 k mean = .7778; overdispersion = .3677 observed proportion poisson prob neg binom prob
  • 14. Whats comparable? Ethnicity Employment status Marital status Education Wealth Limitations in activities of daily living > + interactions with gender/wave/country
  • 15. Mood symptoms over age 1.7 1.5 1.3 1.1 England 0.9 US 0.7 0.5 55 60 65 70 75 80 85 90 95
  • 16. Somatic Symptoms over age by country 1.4 1.3 1.2 1.1 England 1 0.9 0.8 US 0.7 0.6 55 60 65 70 75 80 85 90 95
  • 17. Ethnic differences in mood symptoms 1.4 1.2 1 white ethnic background other ethnic background 0.8 0.6 0.4 0.2 0 England US
  • 18. Partner status and mood symptoms 1.4 1.2 1 0.8 Couple 0.6 Single 0.4 Seperated Widowed 0.2 0 England men England women US men US women
  • 19. Wealth gradient in mood 0.8 0.7 0.6 0.5 0.4 England 0.3 US 0.2 0.1 0 1 2 3 4 5 6 7 8 9 10
  • 20. Educational differences in somatic symptoms 1.2 1 0.8 ELSA HRS 0.6 0.4 0.2 0 low education middle education higher education
  • 21. Somatic symptoms and adl 2 1.8 1.6 1.4 1.2 ELSA Male 1 ELSA female 0.8 HRS male 0.6 HRS female 0.4 0.2 0 0 1 2 3 4 5 6 7 8 9 10 11
  • 22. 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
  • 23. 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
  • 24. 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