Inequalities in elevated depressive symptoms in middle-aged and older adults by rural childhood residence: The important role of education.

OBJECTIVES: To quantify inequalities in the prevalence of elevated depressive symptoms by rural childhood residence and the extent to which childhood socioeconomic conditions and educational attainment contribute to this disparity.

METHODS: We identified the prevalence of depressive symptoms among U.S.-born adults ages ≥50 years in the 1998-2014 waves of the Health and Retirement Study (n=16,022). We compared prevalence of elevated depressive symptoms (>4/8 symptoms) by rural versus non-rural childhood residence (self-report) and the extent to which own education mediated this disparity. We used generalized estimating equations and marginal standardization to calculate predicted probabilities of elevated depressive symptoms.

RESULTS: In age, race/ethnicity, and sex-adjusted models, rural childhood residence was associated with elevated depressive symptoms (OR=1.20; 95% CI: 1.12, 1.29; marginal predicted probability 10.5% for rural and 8.9% for non-rural childhood residence). Adjusting for U.S. Census birth region and parental education attenuated this association (OR=1.07; 95% CI: 0.99, 1.15; marginal predicted probability 9.9% for rural and 9.3% for non-rural). After additional adjustment for own education, rural childhood residence was not associated with elevated depressive symptoms (OR=0.94; 95% CI: 0.87, 1.01; marginal predicted probability 9.2% for rural and 9.8% for non-rural).

CONCLUSIONS: Rural childhood residence was associated with elevated depressive symptoms in middle-aged and older adults; birth region, parental education, and own education appear to contribute to this disparity.