Late-life mental health in Europe: a controlled for measurement bias country level comparison

George B Ploubidis, London School of Hygiene and Tropical Medicine
Emily Grundy, London School of Hygiene and Tropical Medicine (LSHTM)

Demographic changes have prompted increased interest in older people’s health and quality of life of, including the important domain of mental health. Depression is known to be associated with age and with socio-demographic characteristics, but less is known about associations between these factors and positive indicators of mental health, such as well-being. International variations in both depression and well-being may provide further insights into influences on mental health at older ages, but require investigation using methods which allow for possible cultural variation in mental health assessment. We investigated the influence of country of residence on depression and well-being among older Europeans using data from the Survey of Health, Ageing and Retirement in Europe (SHARE), a cross sectional nationally representative population based sample. The analysis sample comprised 13498 older Europeans from 10 countries. The EURO-D was used to measure depression and a well-being outcome was derived from self report items available in SHARE. The between country measurement invariance of both mental health outcomes was established using modern psychometric modelling techniques. After adjustment for demographic characteristics, depression was highest in Spain and generally higher in Mediterranean countries than in other European regions. Well-being was highest in Denmark and generally high in Scandinavian countries included in the sample. Better mental health was associated with higher educational attainment and with being married. Among men older age was associated with higher rates of depression when the presence of chronic illnesses was controlled for in the analysis. We concluded that there is considerable between country heterogeneity in late-life mental health in Europe. The Scandinavian countries appear to do best (low depression/high well being) followed by central European countries, while older people in Mediterranean countries report the worst mental health.