Vuong Diem Khanh DoanMichael Dunne Vo Van Thang Gavin Turrell

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The Association between Socioeconomic status &

Depressionin Vietnamese Adults:

pilot study

The Association between Socioeconomic status &

Depressionin Vietnamese Adults:

pilot study

INTRODUCTION

• A consistent pattern of an inverse relationship socioeconomic status (SES)-depressive symptoms.

• The mechanism not well understood. • A significant barrier• Most research from developed

countries. • In Vietnam, serious dearth of research

on depression & no investigation of SES and depression

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“a common mental disorder that presents with depressed mood, loss of interest or pleasure, feelings of guilt or

low self-worth, disturbed sleep or appetite, low energy, and

poor concentration” (WHO)

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Low SES Negative

emotion and

cognition

DepressionAnxiety

hopelessness

Intermediate paths

- Behavioral factors:

Negative health

practices- Biological pathway

SAMa, HPAb, immune function, metabolic

factors

Intermediate paths

- Behavioral factors:

Negative health

practices- Biological pathway

SAMa, HPAb, immune function, metabolic

factors

Health outcome

MortalityMorbidityQuality of

lifeLife

expectancy

Reserve capacity

- Stressful life events- Social support- Psychological resources

Reserve capacity

- Stressful life events- Social support- Psychological resources

(a)SAM: Sympathetic adrenal - medullary system (b) HPA: Hypothalamic- pituitary-adrenocortical axis

1. What is the prevalence of depression among Vietnamese adults?

2. Is the socioeconomic-depression gradient in Vietnam similar to, or different from other cultures?

3. Among Vietnamese adults, what factors mediate the relationship between SES and depression?

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lowSES

-Education- Income- Occupation- Employment

lowSES

-Education- Income- Occupation- Employment

moreDEPRESSIO

N

moreDEPRESSIO

Nmore Stress

-Lifetime trauma -Chronic stress -Recent life events

more Stress

-Lifetime trauma -Chronic stress -Recent life events

lowerSocial support

lowerSocial support

lowerPsychological

resources- Mastery- Self esteem

lowerPsychological

resources- Mastery- Self esteem

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Phase 2

Part 1Exploratory qualitative research

Part 1Exploratory qualitative research

Part 2Pilot

quantitative research

Part 2Pilot

quantitative research

Main survey Main survey

- 2 in-depth interviews

psychiatrist experts- 10 in-depth

interviews with residents

100 Structured interviews

with residents

Structured interview

• Hue city- Central Vietnam - Population : 350,000- 27 quarters

(15 -25 units / each quarter)

• Phu hoi quarter:- Population: 10,121

- Total unit: 16

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Phu hoi

• Section 1: Demographics & SES • Section 2: Self-esteem : Rosenberg self esteem

scale (RSES)• Section 3: Mastery• Section 4: Social support: Multidimensional

Scale of Perceived Social Support (MSPSS)

• Section 5: Depressive symptoms: Centre for Epidemiological Studies-Depression scale (CES-D)

• Section 6: Stress(Lifetime trauma, chronic stress, recent life events)

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• Randomly selected 5 units / 16 units• From the booklet of each units : - Selected every 5 th households

- Each household: Aged 25-55- 20 households /each booklet- 100 participants/ 104 household

approached (response rate 96%)

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• Descriptive statistics • Bivariate data analysis:

- Chi-square - t-tests, ANOVA

- Simple linear regression • Multivariable data analysis

- OLS regression & 3 steps in Barron & Kenny ‘s Framework

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6.2 6.9

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37.5

Education

Above high school (n=32)

High school ( n= 29)

Secondary school (n=23)

Primary or no school (n=16)

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PREVALENCE OF DEPRESSIVE SYMPTOMS (%)

Figure 1: Prevalence of depressive symptoms ( CES-D > 21) by Education level

4.5

9.77.7

33.3

Income

Highest (n= 22)

Middle high (n=31)

Middle low (n=26)

Lowest (n=21)

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Figure 2: Prevalence of depressive symptoms ( CES-D >21) by Income ( quartile groups)

< 16,000VND (< 1.2 AUD per day)

16,000 - < 26,000 VND (1.2 - < 2.0 AUD per day)

26,000-46,000 VND (2.0 - 3.4 AUD per day)

> 46,000 VND (> 3.4 AUD per day)

5.4

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Occupation

High (n=37)

Medium (n=5)

Low stable (n= 27)

Low unstable (n= 15)

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Figure 3: Prevalence of depressive symptoms ( CES-D >21) by Occupation

casual manual non-specialized workers non-manual workers, no professional qualifications

employed manual non-specialized workers non-manual professional or business people with prestigious post.

1. Very strong social gradient wrt depressive symptoms

• Higher education levels report fewer depressive symptoms

• Only individuals at the bottom of the quartile income were strongly associated with higher depressive symptoms compared with the highest income group)

• U shape in relationship between occupation & depressive symptoms (??)

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2. Mediating effects • Lifetime trauma did not have mediating

effects on SES- depression • Self esteem & mastery have very strong

mediating effects on SES – depression • Recent life events have mediating effects on

3 indicators of SES –depression ( education, income, employment)

• Chronic stress has mediating effects on 2 indicators of SES –depression ( education, income)

• Social support has mediating effects on 1 indicators of SES –depression ( occupation)

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1. Mental health care program in Vietnam:

• New evidence regarding the burden of mental distress in Vietnam.

• Practical relevance for advocacy for mental health promotion and health care services.

2. International scientific literature on the social determinants of depression.

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Thank you!

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