by Konstantina Briola, member of the Social Issues Research Team

Introduction

It is well known that depression is one of the most common mental health illnesses worldwide (Kessler et al., 2009; Wittchen & Jacobi, 2005). According to the World Health Organization (WHO), depression, sometimes referred to as unipolar depression, «is a common mental disorder characterized by sadness, loss of interest in activities and by decreased energy.. is differentiated from normal mood changes that are part of life by the extent of its severity, the symptoms and the duration of the disorder».

Depression is a common illness worldwide, with more than 264 million people affected (GBD 2017 Disease and Injury Incidence and Prevalence Collaborators, 2018).  As an illness is currently ranked fourth among the 10 leading causes of the global burden of disease and among the 4 leading causes of life years lost, disability, and social dysfunction (Υπουργείο Υγείας, 2013), and  it is predicted that by the year 2020, it will have jumped to second place (World Health Organization, 2001).

According to the United Nations, since the outbreak of COVID-19 in Europe, negative impacts on mental health are being addressed across Europe. During this period, feelings of fear, anxiety, anger and sadness are greatly felt by people around the world due to the effects of the coronavirus.

Depression is often referred to as Major Depressive Disorder, and is a common psychiatric disorder that falls into the category of mood disorders. In order for depression as a mood disorder to be separated from the «normal» depressive symptoms that occur under the influence of stressful events, commonly accepted diagnostic criteria with free access have been created by the American Psychiatric Association and the World Health Organization.

The main purpose of this analysis is to measure the incidence of depression in Austria, Spain and the Netherlands, in order to examine whether there are differences in rates between the three countries. At the same time, the possibility of differences in depression rates based on the demographic characteristics of respondents (gender, age, marital status, educational level), in which we expect to encounter differences, will be investigated.

Participants

In the study the sample size in Austria is 1795 cases. More specifically, it consists of 853 men (47.5%) and 942 women (52.5%) ranging in age from 65 and over (23%, mean = 49.22, standard deviation = 1.644). Of these, some are married (45.4%) and have completed secondary education (64.8%).

The sample size in Spain is 1925 cases. In more detail, it consists of 988 men (51.3%) and 937 women (48.7%) ranging in age from 65 and over (21.6%, mean = 48.54, standard deviation = 1.656). Of these, some are married (52.8%) and have completed primary education (55.4%).

The sample size in the Netherlands is 1919 cases. In more detail, it consists of 859 men (44.8%) and 1060 women (55.2%) ranging in age from 65 and over (25.8%, mean = 50.74, standard deviation = 1,652). Of these, some are married (51.7%) and have completed primary education (37.3%).

Procedure

The data for the analysis were collected from the European Social Survey (ESS) database. Specifically, we used data from the ESS survey in 2014 (Round 7), which concerned social inequalities in health and the factors that cause them. For the purpose of our study, a comprehensive analysis was carried out on depression of respondents across Austria, Spain and the Netherlands.

At this point it should be mentioned that for the needs of this work it was deemed appropriate to create a final score of the respondents based on their answers. More specifically, with a minimum value of 8 and a maximum value of 32, the separation was as follows: 8 to 13, 14 to 19, 20 to 25, and 26 to 32.

Also, in this context, it should be noted that the research was conducted in accordance with the  International Statistical Institute code of ethics.

Measurements

In this subsection, a complete description of the measurements used in writing the analysis will be made.

Specifically, to measure depression in the aforementioned countries (Austria, Spain, the Netherlands), respondents were asked how they felt or behaved in the last week. Depression was measured from 1 to 4. More specifically, 1 represents «Never or almost never», 2 represents «Sometimes», 3 represents «Most of the times», and 4 represents «All or almost all the times.» In addition, the level of measurement of the frequency of depression is considered to be pseudo-interval.

Afterwards, the measurement is carried out from 1 to 4, for all three countries. More specifically, 1 represents «Never or almost never», 2 represents «Sometimes», 3 represents «Most of the times», and 4 represents «All or almost all the times». In addition, the level of measurement of the variable «Sex» is considered to be nominal, while the level of measurement of the frequency of depression is considered to be pseudo-interval.

The measurement is then performed from 1 to 4, for all three countries. More specifically, 1 represents «Never or almost never», 2 represents «Sometimes», 3 represents «Most of the times», and 4 represents «All or almost all times». In addition, the level of measurement of the variable «Age» is considered to be nominal, while the level of measurement of the frequency of depression is considered to be pseudo-interval.

The measurement is then performed from 1 to 4, for all three countries. More specifically, 1 represents «Never or almost never», 2 represents «Sometimes», 3 represents «Most of the times», and 4 represents «All or almost all times». In addition, the level of measurement of the variable «Marital status» is considered to be nominal, while the level of measurement of the frequency of depression is considered to be pseudo-interval.

Finally, the measurement is then performed from 1 to 4, for all three countries. More specifically, 1 represents «Never or almost never», 2 represents «Sometimes», 3 represents «Most of the times», and 4 represents «All or almost all times». In addition, the level of measurement of the variable «Educational level» is considered to be ordinal, while the level of measurement of the frequency of depression is considered to be pseudo-interval.

Statistical Analysis

Univariate and bivariate analysis were performed.

Statistical analysis was performed with the use of IBM SPSS Statistics (Version 20).

Results

Tables 1 to 3 present the main characteristics of the respondents (gender, age, marital status, level of education). Specifically, Table 1 presents the demographic characteristics of the respondents in Austria (N = 1795), Table 2 presents the basic demographic characteristics of the respondents in Spain (N = 1925), and finally, Table 3 presents the demographic characteristics of the respondents in the Netherlands. (N = 1919).

Table 4 shows the frequency of depression in responders in Austria, Spain and the Netherlands. According to the data from the Table, there are no particularly large differences in the rates of depression between the three countries. However, what is observed is that Spain, among the other two countries, gathers the largest percentage of people who have «symptoms of depression» and «severe symptoms of depression».

Table 5 shows the frequency of respondents’ depression based on the demographic characteristics of respondents in Austria. According to the data from the table, there are generally no large discrepancies, since the highest percentages are concentrated in the first 2 categories «No depression symptom» and «Mild depression symptoms».

Table 6 shows the frequency of respondents’ depression based on the demographic characteristics of respondents in Spain. According to the data from the table, there are generally no large discrepancies, since the highest percentages are concentrated in the first 2 categories («No depression symptom» and «Mild depression symptoms»).

Table 7 shows the frequency of respondents’ depression based on the demographic characteristics of respondents in the Netherlands. According to the data from the table, there are generally no large discrepancies, since the highest percentages are concentrated in the first 2 categories «No depression symptom» and «Mild depression symptoms».

Conclusions

According to the results we obtained from the tables, on the questions we asked at the beginning, we are now able to draw a number of conclusions.

Initially, regarding the depression rates of the respondents between the three countries (Austria, Spain and the Netherlands), in general there are no large differences in the results (Table 4). However, what we observe is that rates in the «depressive symptoms» and «severe depressive symptoms» categories tend to be higher in Spain, at 8.0% and 2.6%, than in Austria (4.1% and 0.9%), and in the Netherlands (with 4.6% and 1.0% respectively). These results can be attributed to two factors: a) the weather conditions of each country, and b) the economic crisis.

More specifically, regarding the weather conditions, there is a common belief that the risk of depression increases in the areas with the most adverse weather conditions, with a colder climate and lack of sunlight (Okawa et al., 1996). An example of such a country is the Netherlands, which has unpredictable weather conditions. However, studies such as that of Sánchez, Alonso, Martínez, Rastrollo, Gea, and Villegas (2014) show the opposite, finding higher rates of depression in areas with higher average temperatures, day length and less rainfall. Spain has a predominantly warm Mediterranean climate, with dry summers and winters with balanced temperatures. So it is no surprise that Spain is one of the hottest places in Europe.

The other factor concerns the global economic crisis, in which Spain has experienced its effects more strongly than Austria and the Netherlands. More specifically, the international financial crisis that started in 2007 had a detrimental effect on Spain. Spain’s debt increased from 12% of gross domestic product (GDP) in 2009 to over 90% of GDP in 2013. The number of unemployed increased from 1,856,000 in 2007 to 6,202,700 in April 2013 (Quintana & López-Valcárcel, 2009). Naturally, this situation had a significant impact on the mental health of citizens, as poverty, unemployment and mental health are strongly linked (Maresso et al., 2015).The economic crisis has clearly had an impact on both the Netherlands and Austria. However, the two countries’ economies quickly returned to growth from 2010 onwards (Maresso et al., 2015).

Regarding the results from the frequency of depression based on the demographic characteristics of the respondents (Tables 5 to 7), we observe some common patterns between the 3 countries in terms of results. However, in all three countries we see that the correlation coefficient between the variables and the overall depression rate, in all three countries, ranged from 0.025 to 0.178 at the most. Therefore, what we can conclude is that depression is ultimately unrelated to these variables.

Bibliography

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Greek

[12] Υπουργείο Υγείας. (2013). Ανάπτυξη 13 Κατευθυντήριων Οδηγιών Γενικής Ιατρικής για τη διαχείριση των πιο συχνών νοσημάτων και καταστάσεων υγείας στην Πρωτοβάθμια Φροντίδα Υγείας», Κωδικός MIS: 464637 Νόσημα: Κατάθλιψη. Διαθέσιμο εδώ