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Income and the midlife peak in common mental disorder prevalence

Published online by Cambridge University Press:  10 December 2010

I. A. Lang ,
D. J. Llewellyn ,
R. E. Hubbard ,
K. M. Langa  and
D. Melzer
I. A. Lang*
Affiliation:
PenCLAHRC, Peninsula Medical School, University of Exeter, Exeter, UK Public Health Directorate, NHS Devon, Exeter, UK
D. J. Llewellyn
Affiliation:
Epidemiology & Public Health Group, Peninsula Medical School, University of Exeter, Exeter, UK
R. E. Hubbard
Affiliation:
Department of Geriatric Medicine, School of Medicine, Cardiff University, Penarth, South Wales, UK
K. M. Langa
Affiliation:
Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA Veterans Affairs Center for Practice Management and Outcomes Research, Ann Arbor, MI, USA Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
D. Melzer
Affiliation:
Epidemiology & Public Health Group, Peninsula Medical School, University of Exeter, Exeter, UK
*
*Address for correspondence: Dr I. A. Lang, PenCLAHRC, Peninsula Medical School, Veysey Building, Salmon Pool Lane, Exeter EX2 4SG, UK. (Email: iain.lang@pms.ac.uk)
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Abstract

Background

The prevalence of psychological distress and common mental disorders has been shown to peak in midlife but analyses have ignored the association of poor material circumstances with prevalence. This study aimed to test the hypothesis that the midlife prevalence peak occurs only in lower-income households.

Method

Pooled data were used from the annual Health Survey for England, a nationally representative cross-sectional study, on community-dwelling individuals aged ⩾16 years from years 1997 to 2006 (n=100 457). 12-item General Health Questionnaire scores, reported mental illness diagnoses and receipt of relevant medication were assessed in relation to household income and age. Analyses were separated by gender and adjusted for age, ethnicity, smoking, social class, education and co-morbidities.

Results

Prevalence of psychological distress, diagnoses and treatments rose with age until early middle age and declined subsequently. In analyses conducted separately by income categories, this pattern was marked in low-income groups but absent in high-income groups. Income-related inequalities in the prevalence of psychological distress were greatest in midlife; for example, in men aged 45–54 years the odds ratio of receiving psychiatric medication in the lowest income group compared with the highest was 7.50 [95% confidence interval (CI) 4.24–13.27] and in women aged 45–54 years the odds ratio of reporting mental illness was 10.25 (95% CI 6.16–17.05).

Conclusions

An increased prevalence of psychological distress, common mental disorder diagnoses and treatment in midlife is not a universal phenomenon but is found only in those in low-income households. This implies the phenomenon is not inevitable but is potentially manageable or preventable.

Keywords

Age factorslifecoursemental healthmidlifesocioeconomic status
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 7 , July 2011 , pp. 1365 - 1372
Copyright
Copyright © Cambridge University Press 2010

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References

Aldwin, CM, Levenson, MR (2001). Stress, coping, and health at mid-life: a developmental perspective. In The Handbook of Midlife Development (ed. Lachman, M. E.), pp. 188–215. Wiley: New York.Google Scholar
Almeida, DM, Serido, J, McDonal, D (2006). Daily life stressors early and late baby boomers. In The Baby Boomers Grow Up: Contemporary Perspectives on Midlife (ed. Whitbourne, S. K. and Willis, S. L.), pp. 165–183. Routledge: London.Google Scholar
Baltes, P (1987). Theoretical propositions of life-span developmental psychology: on the dynamics between growth and decline. Developmental Psychology 24, 611–626.CrossRefGoogle Scholar
Barbone, F, McMahon, AD, Davey, PG, Morris, AD, Reid, IC, McDevitt, DG, MacDonald, TM (1998). Association of road-traffic accidents with benzodiazepine use. Lancet 352(9137), 1331–1336.CrossRefGoogle ScholarPubMed
Barefoot, JC, Schroll, M (1996). Symptoms of depression, acute myocardial infarction, and total mortality in a community sample. Circulation 93, 1976–1980.CrossRefGoogle Scholar
Bergen, AW, Caporaso, N (1999). Cigarette smoking. Journal of the National Cancer Institute 91, 1365–1375.CrossRefGoogle ScholarPubMed
Blanchflower, DG, Oswald, AJ (2008). Is well-being U-shaped over the life cycle? Social Science & Medicine 66, 1733–1749.CrossRefGoogle ScholarPubMed
Brockman, H (2010). Why are middle-aged people so depressed? Evidence from West Germany. Social Indicators Research 97, 23–42.CrossRefGoogle Scholar
Carstensen, LL, Isaacowitz, DM, Turk-Charles, S (1999). Taking time seriously: a theory of socioeconomic selectivity. American Psychologist 54, 165–181.CrossRefGoogle Scholar
Charles, ST, Reynolds, CA, Gatz, M (2001). Age-related differences and change in positive and negative affect over 23 years. Journal of Personality and Social Psychology 80, 136–151.CrossRefGoogle ScholarPubMed
Cropley, M, Steptoe, A, Joekes, K (1999). Job strain and psychiatric morbidity. Psychological Medicine 29, 1411–1416.CrossRefGoogle ScholarPubMed
Dickey, B, Normand, SLT, Weiss, RD, Drake, RE, Azeni, H (2002). Medical morbidity, mental illness, and substance use disorders. Psychiatric Services 53, 861–867.CrossRefGoogle ScholarPubMed
Dooley, D, Fielding, J, Levi, L (1996). Health and unemployment. Annual Review of Public Health 17, 449–465.CrossRefGoogle ScholarPubMed
Ferrie, JE, Shipley, MJ, Marmot, MG, Stansfeld, S, Smith, GD (1998). The health effects of major organisational change and job insecurity. Social Science and Medicine 46, 243–254.CrossRefGoogle ScholarPubMed
Fryers, T, Melzer, D, Jenkins, R (2003). Social inequalities and the common mental disorders – a systematic review of the evidence. Social Psychiatry and Psychiatric Epidemiology 38, 229–237.CrossRefGoogle ScholarPubMed
Gallo, JJ, Royall, DR, Anthony, JC (1993). Risk factors for the onset of depression in middle age and later life. Social Psychiatry and Psychiatric Epidemiology 28, 101–108.CrossRefGoogle ScholarPubMed
Goldberg, D, Williams, P (1998). A User's Guide to the General Health Questionnaire. NFER-Nelson: Windsor.Google Scholar
Jackson-Triche, ME, Greer Sullivan, J, Wells, KB, Rogers, W, Camp, P, Mazel, R (2000). Depression and health-related quality of life in ethnic minorities seeking care in general medical settings. Journal of Affective Disorders 58, 89–97.CrossRefGoogle ScholarPubMed
Jenkins, R, Lewis, G, Bebbington, P, Brugha, T, Farrell, M, Gill, B, Meltzer, H (1997). The National Psychiatric Morbidity Surveys of Great Britain – initial findings from the Household Survey. Psychological Medicine 27, 775–789.CrossRefGoogle ScholarPubMed
Jones, KM, Whitbourne, SK, Skultety, KM (2006). Identity processes and the transition to midlife among baby boomers. In The Baby Boomers Grow Up: Contemporary Perspectives on Midlife (ed. Whitbourne, S. K. and Willis, S. L.), pp. 149–163. Routledge: London.Google Scholar
Jorm, AF, Windsor, TD, Dear, KBG, Anstey, KJ, Christensen, H, Rodgers, B (2005). Age group differences in psychological distress: the role of psychosocial risk factors that vary with age. Psychological Medicine 35, 1253–1263.CrossRefGoogle ScholarPubMed
Kawachi, I, Sparrow, D, Vokonas, PS, Weiss, ST (1994). Symptoms of anxiety and risk of coronary heart disease: the Normative Aging Study. Circulation 90, 2225–2229.CrossRefGoogle ScholarPubMed
Keyes, CLM, Ryff, CD (1999). Psychological well-being in midlife. In Life in the Middle: Psychological and Social Development in Middle Age (ed. Willis, S. L. and Reid, J. D.), pp. 161–178. Academic Press: San Diego.CrossRefGoogle Scholar
Laaksonen, E, Martikainen, P, Lahelma, E, Lallukka, T, Rahkonen, O, Head, J, Marmot, M (2007). Socioeconomic circumstances and common mental disorders among Finnish and British public sector employees: evidence from the Helsinki Health Study and the Whitehall II Study. International Journal of Epidemiology 36, 776–786.CrossRefGoogle ScholarPubMed
Lachman, ME, Lewkowicz, C, Marcus, A, Ping, Y (1994). Images of midlife development among young, middle-aged, and older adults. Journal of Adult Development 1, 201–211.CrossRefGoogle Scholar
Lahelma, E, Laaksonen, M, Martikainen, P, Rahkonen, O, Sarlio, L (2006). Multiple measures of socioeconomic circumstances and common mental disorders. Social Science and Medicine 63, 1383–1399.CrossRefGoogle ScholarPubMed
Lasser, K, Boyd, JW, Woolhandler, S, Himmelstein, DU, McCormick, D, Bor, DH (2000). Smoking and mental illness: a population-based prevalence study. Journal of the American Medical Association 284, 2606–2610.CrossRefGoogle ScholarPubMed
Lorant, V, Deliege, D, Eaton, W, Robert, A, Philippot, P, Ansseau, M (2003). Socioeconomic inequalities in depression: a meta-analysis. American Journal of Epidemiology 157, 98–112.CrossRefGoogle ScholarPubMed
McClements, L (1978). The Economics of Social Security. Heinemann: London.Google Scholar
McLeod, JD, Kessler, RC (1990). Socioeconomic status differences in vulnerability to undesirable life events. Journal of Health and Social Behavior 31, 162–172.CrossRefGoogle ScholarPubMed
Mangalore, R, Knapp, M, Jenkins, R (2007). Income-related inequality in mental health in Britain: the concentration index approach. Psychological Medicine 37, 1037–1045.CrossRefGoogle ScholarPubMed
Marmot, MG, Smith, GD, Stansfeld, S, Patel, C, North, F, Head, J, White, I, Brunner, E, Feeney, A (1991). Health inequalities among British civil servants: the Whitehall II study. Lancet 337(8754), 1387–1393.CrossRefGoogle ScholarPubMed
Mykletun, A, Bjerkeset, O, Dewey, M, Prince, M, Overland, S, Stewart, R (2007). Anxiety, depression, and cause-specific mortality: the HUNT study. Psychosomatic Medicine 69, 323–331.CrossRefGoogle ScholarPubMed
Ormel, J, Kempen, GIJM, Deeg, DJH, Brilman, EI, van Sonderen, E, Relyveld, J (1998). Functioning, well-being, and health perception in late middle-aged and older people: comparing the effects of depressive symptoms and chronic medical conditions. Journal of the American Geriatrics Society 46, 39–48.CrossRefGoogle ScholarPubMed
Prince, M, Patel, V, Saxena, S, Maj, M, Maselko, J, Phillips, MR, Rahman, A (2007). No health without mental health. Lancet 370(9590), 859–877.CrossRefGoogle ScholarPubMed
Prior, G, Teers, R, Brookes, M, Primatesta, P (2002). Health Survey for England 2000: Methodology and Documentation. The Stationery Office: London.Google Scholar
Ramasubbu, R, Patten, SB (2003). Effect of depression on stroke morbidity and mortality. Canadian Journal of Psychiatry 48, 250–257.CrossRefGoogle ScholarPubMed
Rapp, MA, Gerstorf, D, Helmchen, H, Smith, J (2008). Depression predicts mortality in the young old, but not in the oldest old: results from the Berlin Aging Study. American Journal of Geriatric Psychiatry 16, 844–852.CrossRefGoogle Scholar
Rice, NE, Lang, IA, Henley, W, Melzer, D (2010). Baby boomers nearing retirement: the healthiest generation? Rejuvenation Research 13, 105–114.CrossRefGoogle ScholarPubMed
Skaff, MM (2006). The view from the driver's seat: sense of control in the baby boomers at midlife. In The Baby Boomers Grow Up: Contemporary Perspectives on Midlife (ed. Whitbourne, S. K. and Willis, S. L.), pp. 149–163. Routledge: London.Google Scholar
Snowdon, J (2001). Is depression more prevalent in old age? Australian and New Zealand Journal of Psychiatry 35, 782–787.CrossRefGoogle ScholarPubMed
Staudinger, UM, Bluck, S (2001). A view on mid-life development from life-span theory. In The Handbook of Midlife Development (ed. Lachman, M. E.), pp. 3–39. Wiley: New York.Google Scholar
van Gool, CH, Kempen, GIJM, Penninx, BWJH, Deeg, DJH, Beekman, ATF, van Eijk, JTM (2005). Impact of depression on disablement in late middle aged and older persons: Results from the Longitudinal Aging Study Amsterdam. Social Science and Medicine 60, 25–36.CrossRefGoogle ScholarPubMed