Socioeconomic Status and Depression – A Systematic Review

Abstract

ObjectiveLow socioeconomic status (SES) has been associated with an increased risk of depression and psychiatric disorders in general. In this systematic review and meta-analysis, we aim to provide an estimate of the risk of clinical depression associated with low SES across cultures, age groups and study designs. Finally, we tested whether associations between SES and depression differed by the income of the country in which the study was conducted.MethodsA literature search across five databases returned 7,943 studies. Title, abstract and full text screening resulted in 162 included studies of which 122 were meta-analysed, 22 were included in a cross-sectional narrative review and 19 studies were included in a longitudinal narrative review. Meta-analyses were divided into risk estimates for composite SES, income, education, and employment. Sensitivity analyses based on differences in economic situation in the country of study origin were performed to investigate a possible source of between study heterogeneity.ResultsLow SES was associated with an increased risk of depression across all measures of SES. Low income was associated with the highest odds ratio for depression (OR = 1.96, 95% CI = 1.53-2.52). Sensitivity analyses revealed no significant differences in between-study heterogeneity or risk of depression between high- and low-income economy groups.ConclusionsComparable risks of depression across economy groups suggest that income relative to your peers, rather than absolute income, is a risk factor for depression. Preventative measures and possible policy interventions are discussed.Strengths and limitations of this studyThis systematic review provides the largest and most comprehensive review and meta-analysis of the association between socioeconomic status and depression.The included studies span a broad range of ages, cultures, and country economies, allowing for better generalisation of the results.The inclusion of component parts of socioeconomic status (income, education, and employment) in the meta-analysis allows for comparisons of the different risk estimates.The broad inclusion criteria are likely to allow for increased between-study heterogeneity.Due to the observational nature of the studies included it is difficult to make conclusions on the direction of causality between socioeconomic status and depression. However, the inclusion of a longitudinal narrative review may give an indication of a direction of causality.