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The prospective relationship between social cohesion and depressive symptoms among older adults from Central and Eastern Europe
  1. Carla Bertossi Urzua1,
  2. Milagros A Ruiz1,
  3. Andrzej Pajak2,
  4. Magdalena Kozela2,
  5. Ruzena Kubinova3,
  6. Sofia Malyutina4,5,
  7. Anne Peasey1,
  8. Hynek Pikhart1,
  9. Michael Marmot1,6,
  10. Martin Bobak1
  1. 1 Research Department of Epidemiology and Public Health, University College London, London, UK
  2. 2 Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
  3. 3 Centre for Environmental Health Monitoring, National Institute of Public Health, Prague, Czech Republic
  4. 4 Research Institute of Internal and Preventive Medicine, Branch of the Institute of Cytology and Genetics, SB RAS, Novosibirsk, Russia
  5. 5 Novosibirsk State Medical University, Novosibirsk, Russia
  6. 6 UCL Institute of Health Equity and Research Department of Epidemiology and Public Health, University College London, London, UK
  1. Correspondence to Dr Milagros A Ruiz, Research Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK; m.a.ruiz{at}


Background Social cohesion has a potential protective effect against depression, but evidence for Central and Eastern Europe is lacking. We investigated the prospective association between social cohesion and elevated depressive symptoms in the Czech Republic, Russia and Poland, and assessed whether alcohol drinking and smoking mediated this association.

Methods Cohort data from 15 438 older urban participants from the Health, Alcohol and Psychosocial factors In Eastern Europe project were analysed. Baseline social cohesion was measured by five questions, and depressive symptoms were measured 3 years later by the 10-item Center for Epidemiological Depression (CES-D) Scale. Nested logistic regression models estimated ORs of elevated depressive symptoms (CES-D 10 score ≥4) by z-scores and tertiles of social cohesion.

Results Per 1 SD decrease in social cohesion score, adjusted ORs of elevated depressive symptoms were 1.13 (95% CI 1.05 to 1.23) and 1.05 (95% CI 0.99 to 1.13) in men and women, respectively. Further adjustment for smoking and drinking did not attenuate these associations in either men (OR=1.13, 95% CI 1.05 to 1.22) or women (OR=1.05, 95% CI 0.99 to 1.13). Similarly, the fully adjusted ORs comparing the lowest versus highest social cohesion tertile were 1.33 (95% CI 1.10 to 1.62) in men and 1.18 (95% CI 1.01 to 1.39) in women.

Conclusions Lower levels of social cohesion was associated with heightened depressive symptoms after a 3-year follow-up among older Czech, Russian and Polish adults. These effects appeared stronger in men, and alcohol and smoking played no appreciable role in this association.

  • Central and Eastern Europe
  • cohort study
  • depressive symptoms
  • depression
  • social cohesion
  • social capital

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  • Contributors CBU performed the main statistical analyses, interpreted the study findings and drafted the initial manuscript. MAR provided input to the statistical methodology, performed the sensitivity analysis, commented on the study findings and revised the final manuscript. MB conceptualised and designed the study, oversaw the statistical analyses and helped to finalise the manuscript. APa, MK, RK, SM, APe, HP and MM critically reviewed the final manuscript. All authors approved the final manuscript as submitted. The HAPIEE study was jointly designed by MB, APa, RK, SM and MM.

  • Funding The HAPIEE study is funded by the Wellcome Trust (grants 064947 and 081081), the US National Institute on Aging (grant R01 AG23522-01), the MacArthur Foundation ‘MacArthur Initiative on Social Upheaval and Health’ (grant 712058). The manuscript is supported by a European Commission Horizon 2020 grant, 667661, as part of the Promoting Mental Wellbeing in the Ageing Population: Determinants, Policies and Interventions in European Cities (MINDMAP) research project.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval HAPIEE has received ethical approval by research ethics committees at local centres and University College London.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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