Social Determinants of Health and Incident Depressive Symptoms in Older Adults With Chronic Conditions: Prospective Cohort Study

BACKGROUND: While the role of social determinants of health (SDH) in physical health is well known, their longitudinal contribution to depressive symptoms in chronically ill adults remains understudied. Understanding how socioeconomic disadvantage compounds the psychological burden of chronic disease may inform preventive psychiatry in aging populations. OBJECTIVE: This study examined whether key SDH were associated with the incidence of depressive symptoms among older adults with chronic disease across Europe. METHODS: Using data from waves 1-9 of the Survey of Health, Ageing and Retirement in Europe (SHARE), 12,319 adults aged ≥ 50 years with at least one chronic condition and without depression at baseline were included. Incident depressive symptoms were defined as a EURO-D score ≥ 4 during follow-up. SDH included education, employment, income, and living arrangements. Cox proportional hazards models estimated adjusted hazard ratios (HR) and 95% confidence intervals (CI), controlling for age, sex, smoking, physical activity, BMI, country, and chronic disease. RESULTS: During a median follow-up of 3 years, 3668 new clinically relevant depressive symptom cases occurred. Compared to high education, middle and low education were linked to 15% (HR = 1.15; 95% CI: 1.04-1.27) and 36% higher risk (HR = 1.36; 95% CI: 1.24-1.50). Low income was linked to 10% higher risk (HR = 1.10; 95% CI: 1.02-1.19), and economic inactivity to 17% higher risk (HR = 1.17; 95% CI: 1.08-1.26). CONCLUSION: Socioeconomic disadvantages, reflected in lower education, income, and employment, were associated with a higher incidence of depressive symptoms. Addressing these inequalities within integrated chronic disease and mental-health care may help prevent late-life depression.