Association between depressive symptoms and objective/subjective socioeconomic status among older adults of two regions in Myanmar

Sasaki, Y.; Shobugawa, Yugo; Nozaki, Ikuma; Takagi, Daisuke; Nagamine, Yuiko; Funato, Masafumi; Chihara, Yuki; Shirakura, Yuki; Lwin, Kay Thi; Zin, Poe Ei; Bo, Thae Zarchi; Sone, Toshio; Win, Hla Hla

doi:10.1371/journal.pone.0245489

Cited by 22 publications

(39 citation statements)

References 56 publications

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“…Research from a Swedish cohort in middle-to late-adulthood near retirement suggests higher education and lower SSS were associated with depressive symptoms, results contrary to our findings for association of attained schooling with psychological distress ( Nyberg et al, 2019 ). The association of household wealth with psychological distress is also consistent with results from rural Uganda and Myanmar which found depression was associated with lower SSS and lower self-rated economic status but not cross-sectional wealth ( Sasaki et al, 2021 ; Smith et al, 2019 ). These results are consistent with the relative deprivation hypothesis which suggests social comparisons and personal experiences may influence health and well-being, in addition to objective circumstances ( Wilkinson & Pickett, 2007 ).…”

Section: Discussionsupporting

confidence: 85%

Socioeconomic position over the life-course and subjective social status in relation to nutritional status and mental health among Guatemalan adults

Varghese

Waford

DiGirolamo

et al. 2021

SSM - Population Health

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Objective We study how life course objective socioeconomic position (SEP) predicts subjective social status (SSS) and the extent to which SSS mediates the association of objective SEP with nutritional status and mental health outcomes. Methods We use data from participants of the INCAP Longitudinal Study 1969–2018 (n = 1258) from Guatemala. We use the MacArthur ladder for two measures of SSS - perceived community respect and perceived economic status. We estimate the association of SSS with health outcomes after adjusting for early life characteristics and life course objective SEP (wealth, schooling, employment) using linear regression. We use path analysis to study the extent of mediation by SSS on the health outcomes of body mass index (BMI; kg/m 2 ), psychological distress (using the WHO Self-Reported Questionnaire; SRQ-20) and happiness, using the Subjective Happiness Scale (SHS). Results Median participant rating was 5 [IQR: 3–8] for the perceived community respect and 3 [IQR: 1–5] for the perceived economic status, with no differences by sex. Objective SEP in early life and adulthood were predictive of both measures of SSS in middle adulthood as well as health outcomes (BMI, SRQ-20 and SHS). Perceived community respect (z-scores; 1 z = 3.1 units) was positively associated with happiness (0.13, 95 % CI: 0.07, 0.19). Perceived economic status (z-scores; 1 z = 2.3 units) was inversely associated with psychological distress (−0.28, 95 % CI: −0.47, −0.09). Neither measure of SSS was associated with BMI. Neither perceived community respect nor perceived economic status attenuated associations of objective SEP with health outcomes on inclusion as a mediator. Conclusions Subjective social status was independently associated with happiness and psychological distress in middle adulthood after adjusting for objective SEP. Moreover, association of objective SEP with health was not mediated by SSS, suggesting potentially independent pathways.

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Section: Discussionsupporting

confidence: 85%

Socioeconomic position over the life-course and subjective social status in relation to nutritional status and mental health among Guatemalan adults

Varghese

Waford

DiGirolamo

et al. 2021

SSM - Population Health

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“…However, we can estimate situations of older adults in other regions by the level of urbanization of the selected regions. Ideally, this social epidemiological survey should be extended to include the surrounding regions and states of the entire country [64]. In addition, the self-administered nature of the questionnaire did not allow objective assessment of participants' situations and our measurement of depressive symptoms was based only on GDS scores, without corroborating clinical evaluation.…”

Section: Discussionmentioning

confidence: 99%

Rural–Urban Differences in the Factors Affecting Depressive Symptoms among Older Adults of Two Regions in Myanmar

Sasaki

Shobugawa

Nozaki

et al. 2021

IJERPH

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The aim of the study was to investigate rural–urban differences in depressive symptoms in terms of the risk factors among older adults of two regions in Myanmar to provide appropriate intervention for depression depending on local characteristics. This cross-sectional study, conducted between September and December, 2018, used a multistage sampling method to recruit participants from the two regions, for face-to-face interviews. Depressive symptoms were assessed using the 15-item version of the Geriatric Depression Scale (GDS). Depressive symptoms were positively associated with living in rural areas (B = 0.42; 95% confidence interval (CI): 0.12,0.72), female (B = 0.55; 95% CI: 0.31,0.79), illness during the preceding year (B = 0.68; 95% CI: 0.45,0.91) and non-Buddhist religion (B = 0.57; 95% CI: 0.001,1.15) and protectively associated with education to middle school level or higher (B = −0.61; 95% CI: −0.94, −0.28) and the frequency of visits to religious facilities (B = −0.20; 95% CI: −0.30, −0.10). In women in urban areas, depressive symptoms were positively associated with illness during the preceding year (B = 0.78; 95% CI: 0.36, 1.20) and protectively associated with education to middle school level or higher (B = −0.67; 95% CI: −1.23, −0.11), middle or high wealth index (B = −0.92; 95% CI: −1.59, −0.25) and the frequency of visits to religious facilities (B = −0.20; 95% CI: −0.38, −0.03). In men in rural areas, illness during the preceding year was positively associated with depressive symptoms (B = 0.87; 95% CI: 0.33, 1.42). In women in rural areas, depressive symptoms were positively associated with illness during the preceding year (B = 0.83; 95% CI: 0.36, 1.30) and protectively associated with primary education (B = −0.62; 95% CI: −1.12, −0.12) and the frequency of visits to religious facilities (B = −0.44; 95% CI: −0.68, −0.21). Religion and wealth could have different levels of association with depression between older adults in the urban and rural areas and men and women. Interventions for depression in older adults should consider regional and gender differences in the roles of religion and wealth in Myanmar.

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“…However, no public health organizations in Myanmar have implemented psychological health care policies, to the best of our knowledge. Consequently, psychological health services are not prioritized in primary health care, thus preventing thousands of people from accessing the services they need [ 36 , 38 ]. Several health organizations provide community-based healthcare services, even in remote areas, and seek to coordinate health service provision with the central healthcare system [ 39 ].…”

Section: Introductionmentioning

confidence: 99%

“…There are few published studies on the mental health of older adults in Myanmar, owing to the country’s international isolation. Although we have investigated the association between depressive symptoms and objective/subjective ES in a previous study [ 38 ], happiness and depressive symptoms are not completely contradictory concepts: happiness does not mean exhibiting non-depressive symptoms [ 43 ]. Therefore, it is crucial to examine the factors associated with happiness among older adults in Myanmar, as happiness can buffer psychological and morbidity risks and functional dependence.…”

Section: Introductionmentioning

confidence: 99%

Association between Happiness and Economic Status among Older Adults in Two Myanmar Regions

Sasaki

Shobugawa

Nozaki

et al. 2022

IJERPH

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Few studies have examined whether objective or subjective economic status (ES) has a greater association with the happiness of older adults, despite concerns regarding the growing economic cost of morbidity and their functional dependence in developing countries with aging populations. Thus, this study examined whether objective/subjective ES was associated with happiness in older adults in two Myanmar regions. A multistage random sampling procedure and face-to-face interviews were conducted in the urban and rural areas of Myanmar. The happiness of 1200 participants aged >60 years was evaluated using a single happiness score ranging from 0 (very unhappy) to 10 (very happy). The wealth index, used as an objective ES, was calculated from 17 household asset items, such as radio, washing machines, and television. Subjective ES was assessed by asking “Which of the following best describes your current financial situation in light of general economic conditions?” Responses ranged from “very difficult” to “very comfortable”. Both low objective and subjective ES were negatively associated with happiness, after adjusting for confounding variables and stratification by region (urban and rural areas). Although objective and subjective ES had similar associations with happiness in urban areas, subjective ES had a stronger association in rural areas.

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Association between depressive symptoms and objective/subjective socioeconomic status among older adults of two regions in Myanmar

Cited by 22 publications

References 56 publications

Socioeconomic position over the life-course and subjective social status in relation to nutritional status and mental health among Guatemalan adults

Socioeconomic position over the life-course and subjective social status in relation to nutritional status and mental health among Guatemalan adults

Rural–Urban Differences in the Factors Affecting Depressive Symptoms among Older Adults of Two Regions in Myanmar

Association between Happiness and Economic Status among Older Adults in Two Myanmar Regions

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