Research report
Symptoms of depression in the Estonian population: prevalence, sociodemographic correlates and social adjustment

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Abstract

Objective: The current study presents data on the prevalence of depressive symptoms in the Estonian population and examines associated sociodemographic factors and subjective aspects of social adjustment. Method: The data came from the Estonian Health Interview Survey where 4711 persons aged 15–79 were interviewed. This study included 4677 respondents who answered the Emotional State Questionnaire (EST-Q), a self-rating scale of depression and anxiety. Data on the sociodemographic factors and domains of social adjustment were derived from structured interviews. Results: Depressive symptoms were observed in 11.1% of the respondents. Depressiveness was more common among women, in older age groups, among those not married, in ethnic groups other than Estonians, in lower income groups, and among the unemployed and economically inactive respondents. Depressive subjects were less satisfied, had a more pessimistic prognosis about the future and lower self-rated health. A low level of perceived control was a significant correlate of depression. The association of depressiveness with poor subjective social adjustment remained significant even after controlling for objective circumstances. Limitations: Depression was identified by a self-rate questionnaire, therefore results can not be generalized to clinical depression without caution. Conclusion: Depressive symptoms in the Estonian population were strongly related to socioeconomic functioning. Results emphasize that subjective social adjustment and perceived control are important characteristics of depression and should be considered in assessment and treatment.

Introduction

Mood disorders are among the most frequent mental disorders in the general population (Kessler et al., 1994). A recent pan-European study (DEPRES) showed that the 6-month prevalence of major depression ranged from 3.8 to 9.9% in different countries and subsyndromal depressive symptoms were even more common (Lépine et al., 1997). Studies of the correlates of depression have yielded varying results but nearly always a higher prevalence of depression is found in women and a negative association with some indicator of socioeconomic status is observed (Blazer et al., 1994, Kessler et al., 1997). Apart from its frequent occurrence, depression is a highly disabling condition (Judd et al., 1996, Kessler et al., 1997, Lecrubier, 2000). In understanding motivational and functional impairment in depression the concepts of social adjustment and social functioning have been used interchangeably (Hirschfeld et al., 2000, Weissman, 2000). Social adjustment encompasses objective and subjective role performance in the main areas of life, such as work, economic situation, family, leisure and relationships (Hirschfeld et al., 2000, Weissman, 2000, Bosc, 2000). Objective adjustment includes indices of a sociodemographic nature, namely income, occupation, education, marital status, as well as more specific data about role functioning. Subjective adjustment is defined in terms of the satisfaction, enjoyment and interest people derive from their role performance and relationships. Recent studies have borrowed ideas from cognitive and interpersonal theories of depression stressing the role of relationships and sense of control (Bosc, 2000). This is a logical sequel to studies showing that different health problems including depression are related to low self-efficacy, a low sense of control and pessimistic attitudes (Seligman, 1975, Beck, 1976, Rodin and Salovey, 1989).

Interest in social adjustment has arisen from the necessity of assessing the consequences of depression and differentiating the efficacy of treatments. Depressed subjects have shown marked impairment in social adjustment in both the short-term and long-term perspectives (Thornicroft and Sartorius, 1993). Depression affects the individual’s quality of life and impairs functioning more than any anxiety disorder, and as much as the most common medical conditions (Wells et al., 1989; Ormel et al., 1994).

One reason for undertaking the present study was the great social and economic differentiation that emerged in Estonian society during the 1990s. A recent study of general self-rated health showed that health resources are not equally distributed amongst the Estonian population (Leinsalu, 2002). We suggest that greater social variability also affects the distribution of mental disorders in the population, thus presenting a unique possibility for studying the relationship of depression with socioeconomic correlates and subjective adjustment. The aim of the study was to investigate the prevalence of depressive symptoms in the general population in Estonia during the mid 1990s, and to analyze the relationship of depressiveness with sociodemographic indicators and subjective aspects of social adjustment.

Section snippets

Procedure and subjects

The study is part of the Estonian Health Interview Survey (EHIS), a population based survey of health, health-related behaviours and background factors (Leinsalu et al., 1998). The survey, which consisted of face-to-face structured interviews, was carried out in 1996–1997. The multistage random sample of individuals was drawn from the 1989 census dataset. Persons aged 15–64 were sampled in proportion to their sex and age composition in the sampling unit; persons aged over 65 were over-sampled.

Results

A general description of the sample is presented in Table 1. The results indicate that 11.1% (weighted by age, S.E. 0.5) of the Estonian population had suffered from significant depressive symptoms during the previous 4 weeks. Depression was more common in women (14.9%, S.E. 1.8) than in men (6.7%, S.E. 1.8).

Table 1 presents the association of depression with sociodemographic factors, sense of control and scope of relationships. According to model 1, the odds of having depressive symptoms were

Discussion

Our study showed that in Estonia the 4-week prevalence of significant depressive symptoms (comparable in severity to major depression) was 11.1%, which is higher than the 1-month prevalence of major depression found in population studies based on structured interviews (Blazer et al., 1994, Murphy et al., 2000). As a self-rate instrument, the EST-Q identifies not only respondents with major depression but also those with depressive reactions. Thus, the obtained prevalence of depressiveness is a

Acknowledgments

This study was partly supported by the Estonian National Research and Development Program in Public Health, grant 99-37. We kindly thank Andrew Stickley, from the Stockholm Centre on Health of Societies in Transition, who took the time to correct the English.

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