Factors Associated with Self-Reported Depression, Diagnosis, and Treatment among Korean Adults
- Haejong Lee1, Kyung Sook Cho2,3,, Jangho Yoon2,4, Hyun Suk Park5
- Received January 11, 2014 Accepted March 17, 2014
- ABSTRACT
-
- Background
- We compared factors associated with self‐reported depression and, in particular, diagnosis and treatment of depressive symptoms in Korean adults.
- Methods
- The sample included 13,306 adults aged 19 years or older from the 2010 and 2011 Korea National2 test and multivariate lo-Health and Nutrition Examination Survey (KNHANES Ⅴ). Data were applied to the χ gistic regression analysis.
- Results
- The following characteristics of individuals are significantly associated with self-reported depression: female (vs. male, OR [odds ratio]=3.35), ages 50–59 years (vs. 60+, OR=1.45), economic status (low vs. high, OR=1.35; middle-low vs. high OR=1.29), unemployed (vs. employed, OR=1.23), education (elementary vs. college, OR=1.18; middle school vs. college, OR=1.27; vs. high school vs. college, OR=1.18), current smoking (vs. no, OR=1.19), high-risk alcohol consumption (vs. no, OR=1.18), perceived health (good vs. very good/excellent, OR=1.156; poor/fair vs. very good/excellent, OR=2.65), chronic disease (vs. no, OR=1.26), activity limitation due to health problems (vs. no, OR=1.74), and being in a sickbed during the past month (vs. not in a sickbed, OR=1.69). Living in a metropolitan area (vs. rural, OR=1.40) is significantly associated with greater odds of being diagnosed with depression. The odds of being treated for depression are lower for female (vs. male, OR=0.53). Greater odds of being treated for depression was seen for those with chronic conditions (vs. no, OR=1.73) and activity limitation due to health problems (vs. no, OR=2.05), as well as, those in a sickbed (vs. not, OR=1.88).
- Conclusions
- Applying our findings, policy makers should address the lower rates of depression diagnosed in non-metropolitan areas to reduce regional variations, and also promote treatment in females.
Table 1.
Self-reported depression, diagnosis, and treatment by socioeconomic characteristicsa
| Variables | Self-reported depression (n=13,306) | Diagnosis of depression (n=1,863) | Treatment of depression (n=501) | ||||||
|---|---|---|---|---|---|---|---|---|---|
| No | Yes | Pb | No | Yes | Pb | No | Yes | Pb | |
| Gender | |||||||||
| Male | 4,876 (92.8) | 378 (7.2) | <0.001 | 289 (76.5) | 89 (23.5) | 0.056 | 56 (62.9) | 33 (37.1) | 0.069 |
| Female | 5,538 (78.8) | 1,485 (21.2) | 1,073 (72.3) | 412 (27.7) | 295 (71.6) | 117 (28.4) | |||
| Age, y | |||||||||
| 19–29 | 1,290 (89.4) | 153 (10.6) | <0.001 | 108 (70.6) | 45 (29.4) | 0.034 | 38 (84.4) | 7 (15.6) | 0.150 |
| 30–39 | 2,044 (87.1) | 303 (12.9) | 237 (78.2) | 66 (21.8) | 50 (75.8) | 16 (24.2) | |||
| 40–49 | 1,947 (88.0) | 266 (12.0) | 205 (77.1) | 61 (22.9) | 41 (67.2) | 20 (32.8) | |||
| 50–59 | 1,922 (81.6) | 433 (18.4) | 299 (69.1) | 134 (30.9) | 90 (67.2) | 44 (32.8) | |||
| 60+ | 3,211 (81.9) | 708 (18.1) | 513 (72.5) | 195 (27.5) | 132 (67.7) | 63 (32.3) | |||
| Residential area | |||||||||
|
Metropolitan Small & medium-sized |
4,795 (85.3) 3,657 (84.8) |
824 (14.7) 657 (15.2) |
0.179 |
585 (71.0) 487 (74.1) |
239 (29.0) 170 (25.9) |
0.153 |
162 (67.8) 129 (75.9) |
77 (32.2) 41 (24.1) |
0.111 |
| Rural | 1,962 (83.7) | 382 (16.3) | 290 (75.9) | 92 (24.1) | 60 (65.2) | 32 (34.8) | |||
| Economic status | |||||||||
| Low | 1,922 (78.8) | 518 (21.2) | <0.001 | 376 (72.6) | 142 (27.4) | 0.600 | 89 (62.7) | 53 (37.3) | 0.057 |
| Middle-low | 2,607 (83.5) | 514 (16.5) | 378 (73.5) | 136 (26.5) | 95 (69.9) | 41 (30.1) | |||
|
Middle-high High |
2,908 (87.0) 2,862 (88.1) |
432 (12.9) 385 (11.9) |
326 (75.5) 275 (71.4) |
106 (24.5) 110 (28.6) |
77 (72.6) 86 (78.2) |
29 (27.4) 24 (21.8) |
|||
| Education | |||||||||
| Elementary school and under | 2,862 (88.1) | 385 (11.9) | <0.001 | 489 (70.0) | 210 (30.0) | 0.065 | 137 (65.2) | 73 (34.8) | 0.046 |
| Middle school | 1,111 (82.5) | 236 (17.5) | 173 (73.0) | 63 (27.0) | 40 (63.5) | 23 (36.5) | |||
| High school | 3,519 (86.5) | 549 (13.5) | 406 (74.0) | 143 (26.0) | 108 (75.5) | 35 (24.5) | |||
| College and over | 3,313 (89.8) | 376 (10.2) | 291 (77.4) | 85 (22.6) | 66 (77.6) | 19 (22.4) | |||
| Occupation | |||||||||
| Unemployed | 3,996 (80.0) | 1,007 (20.0) | <0.001 | 721 (71.6) | 286 (28.4) | 0.067 | 191 (66.8) | 95 (33.2) | 0.040 |
| Employed | 6,412 (88.3) | 853 (11.7) | 638 (74.8) | 215 (25.2) | 160 (74.4) | 55 (25.6) | |||
| Living with others | |||||||||
| Living alone | 670 (80.0) | 168 (20.0) | <0.001 | 127 (75.6) | 41 (24.4) | 0.253 | 26 (63.4) | 15 (36.6) | 0.212 |
| Not alone | 9,740 (85.2) | 1,695 (14.8) | 1,235 (72.9) | 460 (27.1) | 325 (70.7) | 135 (29.3) | |||
| BMI, kg/m2 | |||||||||
| <18.5 | 477 (84.6) | 87 (15.4) | 0.970 | 64 (73.6) | 23 (26.4) | 0.140 | 20 (87.0) | 3 (13.0) | 0.175 |
| 18.5–25 | 6,582 (84.7) | 1,187 (15.3) | 884 (74.5) | 303 (25.5) | 212 (70.0) | 91 (30.0) | |||
| >25 | 3,276 (84.9) | 584 (15.1) | 409 (70.0) | 175 (30.0) | 119 (68.0) | 56 (32.0) | |||
Table 2.
Self-reported depression, diagnosis, and treatment by health behaviors and health statusa
| Variables | Self-reported depression | Diagnosis of depression (n= =1,863) | Treatment of depression (n=501) | ||||||
|---|---|---|---|---|---|---|---|---|---|
| No | Yes | Pb | No | Yes | Pb | No | Yes | Pb | |
| Health behaviors | |||||||||
| Currently smoking | |||||||||
| No | 8,106 (83.6) | 1,587 (16.4) | <0.001 | 1,151 (72.5) | 436 (27.5) | 0.088 | 313 (71.8) | 123 (28.2) | 0.045 |
| Yes | 2,284 (89.4) | 270 (10.6) | 207 (76.7) | 63 (23.3) | 38 (60.3) | 25 (39.7) | |||
| High-risk alcohol use | |||||||||
| No | 5,274 (82.0) | 1,156 (18.0) | <0.001 | 835 (72.2) | 321 (27.8) | 0.154 | 220 (68.5) | 101 (31.5) | 0.186 |
| Yes | 5,128 (87.9) | 706 (12.1) | 526 (74.5) | 180 (25.5) | 131 (72.8) | 49 (27.2) | |||
| Physical activities | |||||||||
| No | 5,459 (84.5) | 1,005 (15.5) | 0.103 | 731 (72.7) | 274 (27.3) | 0.376 | 191 (69.7) | 83 (30.3) | 0.405 |
| Yes | 4,922 (85.3) | 849 (14.7) | 624 (73.5) | 225 (26.5) | 160 (71.1) | 65 (28.9) | |||
| Health status | |||||||||
| Perceived health | |||||||||
| Excellent/Very good | 3,868 (91.4) | 364 (8.6) | <0.001 | 284 (78.0) | 80 (22.0) | 0.034 | 68 (85.0) | 12 (15.0) | <0.001 |
| Good | 4,823 (86.0) | 788 (14.0) | 576 (73.1) | 212 (26.9) | 155 (73.1) | 57 (26.9) | |||
| Poor/Fair | 1,723 (70.8) | 711 (29.2) | 502 (70.6) | 209 (29.4) | 128 (61.2) | 81 (38.8) | |||
| Chronic disease | |||||||||
| No | 6,863 (87.9) | 943 (12.1) | <0.001 | 705 (74.8) | 238 (25.2) | 0.057 | 186 (78.2) | 52 (21.8) | <0.001 |
| Yes | 3,550 (79.4) | 920 (20.6) | 657 (71.4) | 263 (28.6) | 165 (62.7) | 98 (37.3) | |||
| Activity limitation | |||||||||
| No | 9,428 (87.0) | 1,411 (13.0) | <0.001 | 1,049 (74.3) | 362 (26.7) | 0.019 | 278 (76.8) | 84 (23.2) | <0.001 |
| Yes | 984 (68.6) | 451 (31.4) | 312 (69.2) | 139 (30.8) | 73 (52.5) | 66 (47.5) | |||
| Sickbed | |||||||||
| No | 9,692 (86.4) | 1,525 (13.6) | <0.001 | 1,130 (74.1) | 395 (25.9) | 0.028 | 292 (73.9) | 103 (26.1) | <0.001 |
| Yes | 720 (68.2) | 336 (31.8) | 231 (68.8) | 105 (31.2) | 59 (56.2) | 46 (43.8) | |||
Table 3.
Factors related to self-reported depression, diagnosis, and treatmenta
| Variables | OR | |||
|---|---|---|---|---|
| Self-reported depression (n=13,306) | Diagnosis of depression (n=1,863) | Treatment of depression (n=501) | ||
| Socioeconomic characteristics | ||||
| Gender (ref: Male) | 3.35b | 1.25 | 0.53b | |
| Age (ref: 60+) | 19–29 | 0.92 | 1.36 | 0.96 |
| 30–39 40–49 | 1.23 1.11 | 0.88 0.92 | 1.40 1.87 | |
| 50–59 | 1.45b | 1.25 | 1.41 | |
| Residential area (ref: Rural) | Metropolitan | 1.11 | 1.40c | 1.13 |
| Small & medium-sized | 1.14 | 1.22 | 0.70 | |
| Economic status (ref: High) | Low | 1.35d | 0.84 | 1.39 |
| Middle-low | 1.29d | 0.85 | 1.26 | |
| Middle-high | 1.09 | 0.80 | 1.36 | |
| Occupation (ref: Employed) | 1.23d | 1.08 | 1.24 | |
| Education (ref: College) | Elementary school | 1.26c | 1.48 | 1.31 |
| Middle school | 1.27c | 1.21 | 1.28 | |
| High school | 1.18c | 1.19 | 0.85 | |
|
Living with others (ref: No) BMI (ref: Under weight) |
Normal |
1.22 1.04 |
1.22 0.93 |
1.23 2.41 |
| Overweight and obesity | 0.93 | 1.14 | 2.09 | |
| Health behaviors | ||||
| Currently smoking (ref: No) | 1.19c | NA | NA | |
| High-risk alcohol use (ref: No) | 1.18d | NA | NA | |
| Physical activities (ref: Yes) | 0.91 | NA | NA | |
| Health status | ||||
|
Perceived health (ref: Excellent/Very good) |
Good Poor/Fair |
1.52b 2.65b |
1.28 1.28 |
2.06 2.00 |
| Chronic disease (ref: No) | 1.26b | 0.98 | 1.73c | |
| Activity limitation (ref: No) | 1.74b | 1.16 | 2.05d | |
| Sickbed (ref: No) | 1.69b | 1.22 | 1.88c | |
- REFERENCES
- REFERENCES
References
1. World Health organization. Public health action for the prevention of suicide: a framework. Geneva: WHO; 2012. [Accessed December 10, 2013].. http://apps.who.int/iris/bitstream/10665/75166/1/9789241503570_eng.pdf.2. Korea Centers for Disease Control and Prevention. 2011 Korean national health and nutrition examination survey. Cheongwon: KCDC; 2012. https://knhanes.cdc.go.kr/knhanes/index.do.3. Ministry of Health and Welfare. 2011 The epidemiological survey of mental disorders in Korea. Seoul: Ministry of Health and Welfare, Seoul National University; 2011. http://welfare24.tistory. com/95..4. Kim JM, Lee JA. Depression and health status in the elderly. J Korean Gerontological Society 2010;30(4):1311-27.5. Chiang HH, Livneh H, Yen ML, Li TC, Tsai TY. Prevalence and correlates of depression among chronic kidney disease patients in Taiwan. BMC Nephrol 2013;14:78.
[Article] [PubMed] [PMC]6. Centers for Disease Control and Prevention. Mental illness surveillance among adults in the United States. MMWR (Morbidity and Mortality Weekly Report 2011;60(3):1-31. [Accessed December 10, 2013].. http://www.cdc.gov/mmwr/preview/mmwrhtml/su6003a1htm?s_cid=su6003a1_w.7. Kim YJ. Comparison of health habits, perceived stress, depression, and suicidal thinking by gender between elders living alone and those living with others. J Korean Acad Fundam Nurs 2009;16(3):333-44.8. Grammatikopoulos L, Koutentakis C. Social activity and participation as determinants of anxiety and depression among elderly in primary care. Annals of General Psychiatry 2010;9(Suppl 1):S137.
[Article] [PMC]9. Al-Nsour M, Zindah M, Belbeisi A, Rolle IV, Walke H, Strine T, et al. Frequent mental distress, chronic conditions, and adverse health behaviors in the behavioral risk factor surveillance survey, Jordan, 2007. Prev Chronic Dis 2013;10:130030.
[Article] [PubMed] [PMC]10. Kim RB, Park KS, Lee JH, Kim BJ, Chun JH. Factors related to depression symptom and the influence of depression symptom on self-rated health status, outpatient health service utilization and quality of life. Korean Journal of Health Education and Promotion 2011;28(1):81-92.11. Yoon J, Bernell SL. The role of adverse physical health events on the utilization of mental health services. Health Serv Res 2013;48(1):175-94.
[Article] [PubMed] [PMC]12. Wells KB, Sherbourne CD. Functioning and utility for current health of patients with depression or chronic medical conditions in managed, primary care practices. Arch Gen Psychiatry 1999;56(10):897-904.
[Article] [PubMed]13. Hirschfeld RA, Montgomery SA, Keller MB, Kasper S, Schatzberg AF, Möller HJ, et al. Social functioning in depression: a review. J Clin Psychiatry 2000;61(4):268-75.
[Article] [PubMed]14. Spitzer RL, Kroenke K, Linzer M, Hahn SR, Williams JW, deGruy III FV, et al. Health-related quality of life in primary care patients with mental disorders: results from the PRIME-MD 1000 study. JAMA 1995;274(19):1511-7.
[Article] [PubMed]15. Wells KB, Stewart A, Hays RD, Burnam MA, Rogers W, Daniels M, et al. The functioning and wellbeing of depressed patients: results from the medical outcomes study. JAMA 1989;262(7):914-9.
[Article] [PubMed]16. Ministry of Health and Welfare. 2001 The Epidemiological survey of mental disorders in Korea. Seoul: Ministry of Health and Welfare, Seoul National Hospital; 2002. http://stat.mw.go.kr/front/statData/publicationView.jsp?menuId=47&bbsSeq=13&nttSeq=235&searchKey=&searchWord=&nPage=13.17. Regier DA, Narrow WE, Rae DS, Manderscheid RW, Locke BZ, Goodwin FK. The de facto US mental and addictive disorders service system: epidemiologic catchment area prospective 1-year prevalence rates of disorders and services. Arch Gen Psychiatry 1993;50(2):85-94.
[Article] [PubMed]18. Kessler RC, Zhao S, Katz SJ, Kouzis AC, Frank RG, Edlund M, et al. Past-year use of outpatient services for psychiatric problems in the national comorbidity survey. Am J Psychiatry 1999;156(1):115-23.
[Article] [PubMed]19. Narrow WE, Regier DA, Rae DS, Manderscheid RW, Locke BZ. Use of services by persons with mental and addictive disorders: findings from the national institute of mental health epidemiologic catchment area program. Arch Gen Psychiatry 1993;50(2):95-107.
[Article] [PubMed]20. USDHHS. Mental Health: a report of the Surgeon General. Washington, DC:United States Department of Health and Human Services, Centers for Disease Control and Prevention, Office of the Surgeon General;1999. [Accessed December 10, 2013].. http://www.surgeongeneral.gov/library/mentalhealth/home.html.21. Olfson M, Marcus SC, Tedeschi M, Wan GJ. Continuity of antidepressant treatment for adults with depression in the United States. Am J Psychiatry 2006;163(1):101-8.
[Article] [PubMed]22. Lee KU, Kim W, Min KJ, Shin YC, Chung SK, Bahk WM. The rate and risk factors of early discontinuation of antidepressant treatment in patients with major depressive disorder. Korean J Psychopharmacol 2006;17(6):550-6.23. Chung JW, YL Oh, Chea HL, Yoon SM, Choi JH, Whang DS. Mental health resources in Korea. Seoul: Ministry of Health and Welfare, Korea Institute for Health and Social Affairs; 2012. https://www.kihasa.re.kr/html/jsp/publication/policy/list. jsp?key=title&ryear_value=2014&query=%C1%A4% BD%C5..24. Zuckerbrot RA, Jensen PS. Improving recognition of adolescent depression in primary care. Arch Pediatr Adolesc Med 2006;160(7):694-704.
[Article] [PubMed]25. Cepoiu M, McCusker J, Cole MG, Sewitch M, Belzile E, Ciampi A. Recognition of depression by non-psychiatric physicians-a systematic literature review and metaanalysis. J Gen Intern Med 2008;23(1):25-36.
[Article] [PubMed] [PMC]26. World Health Organization. Mental Health Atlas 2011. Geneva: WHO; 2011. [Accessed December 10, 2013].. http://whqlibdoc.who.int/publications/2011/9799241564359_eng.pdf.