Depressive symptoms, education, gender and history of migration - an intersectional analysis using data from the German National Cohort (NAKO)
Abstract Background The educational gradient in depressive symptoms is well documented. Gender and history of migration have also been found to be associated with depressive symptoms. Intersectional approaches enable the analysis of the interplay of different social factors at a time to gain a deepe...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-04-01
|
| Series: | International Journal for Equity in Health |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12939-025-02479-2 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850139282063228928 |
|---|---|
| author | Nico Vonneilich Heiko Becher Klaus Berger Patricia Bohmann Hermann Brenner Stefanie Castell Nico Dragano Volker Harth Stefanie Jaskulski André Karch Thomas Keil Lilian Krist Berit Lange Michael Leitzmann Janka Massag Claudia Meinke-Franze Rafael Mikolajczyk Nadia Obi Tobias Pischon Marvin Reuter Börge Schmidt Ilais Moreno Velásquez Henry Völzke Christian Wiessner Olaf von dem Knesebeck Daniel Lüdecke |
| author_facet | Nico Vonneilich Heiko Becher Klaus Berger Patricia Bohmann Hermann Brenner Stefanie Castell Nico Dragano Volker Harth Stefanie Jaskulski André Karch Thomas Keil Lilian Krist Berit Lange Michael Leitzmann Janka Massag Claudia Meinke-Franze Rafael Mikolajczyk Nadia Obi Tobias Pischon Marvin Reuter Börge Schmidt Ilais Moreno Velásquez Henry Völzke Christian Wiessner Olaf von dem Knesebeck Daniel Lüdecke |
| author_sort | Nico Vonneilich |
| collection | DOAJ |
| description | Abstract Background The educational gradient in depressive symptoms is well documented. Gender and history of migration have also been found to be associated with depressive symptoms. Intersectional approaches enable the analysis of the interplay of different social factors at a time to gain a deeper understanding of inequalities in depressive symptoms. In this study, intersectional inequalities in depressive symptoms according to education, gender and history of migration are analysed. Methods The German National Cohort (NAKO, N = 204,783) collected information on depressive symptoms (PHQ-9), which was used as an outcome variable. Educational attainment (ISCED-97), gender, and history of migration constituted the different social strata in the analyses. The predicted probabilities of depressive symptoms for 30 social strata were calculated. Multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) was applied, using logistic regression and social strata were introduced as higher-level unit interaction terms. Results The analyses revealed an educational gradient in depressive symptoms, with differences within each educational group when gender and history of migration were introduced to the models. The predicted probabilities of depressive symptoms varied between the most advantaged and the most disadvantaged social strata by more than 20% points. Among the three studied variables, education contributed the most to the variance explained by the MAIHDA models. The between-strata differences were largely explained by additive effects. Conclusions We observed a robust educational gradient in depressive symptoms, but gender and history of migration had substantial contribution on the magnitude of educational inequalities. An intersectional perspective on inequalities in depressive symptoms enhances current knowledge by showing that different social dimensions may intersect and contribute to inequalities in depressive symptoms. Future studies on inequalities in depression may greatly benefit from an intersectional approach, as it reflects lived inequalities in their diversity. |
| format | Article |
| id | doaj-art-7dcd0b06be59407db5fb17594c98aeb3 |
| institution | OA Journals |
| issn | 1475-9276 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal for Equity in Health |
| spelling | doaj-art-7dcd0b06be59407db5fb17594c98aeb32025-08-20T02:30:22ZengBMCInternational Journal for Equity in Health1475-92762025-04-0124111110.1186/s12939-025-02479-2Depressive symptoms, education, gender and history of migration - an intersectional analysis using data from the German National Cohort (NAKO)Nico Vonneilich0Heiko Becher1Klaus Berger2Patricia Bohmann3Hermann Brenner4Stefanie Castell5Nico Dragano6Volker Harth7Stefanie Jaskulski8André Karch9Thomas Keil10Lilian Krist11Berit Lange12Michael Leitzmann13Janka Massag14Claudia Meinke-Franze15Rafael Mikolajczyk16Nadia Obi17Tobias Pischon18Marvin Reuter19Börge Schmidt20Ilais Moreno Velásquez21Henry Völzke22Christian Wiessner23Olaf von dem Knesebeck24Daniel Lüdecke25Institute of Medical Sociology, University Medical Center Hamburg-EppendorfInstitute of Global Health, University Hospital HeidelbergInstitute of Epidemiology and Social Medicine, University of MünsterDepartment of Epidemiology and Preventive Medicine, University of RegensburgDivision of Clinical Epidemiology and Ageing Research, German Cancer Research Center (DKFZ)Department for Epidemiology, Helmholtz Centre for Infection ResearchInstitute of Medical Sociology, Centre for Health and Society, University Hospital and Medical Faculty, Heinrich Heine University DüsseldorfInstitute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-EppendorfInstitute for Prevention and Cancer Epidemiology, Faculty of Medicine and Medical Center, University of FreiburgInstitute of Epidemiology and Social Medicine, University of MünsterInstitute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin BerlinInstitute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin BerlinDepartment for Epidemiology, Helmholtz Centre for Infection ResearchDepartment of Epidemiology and Preventive Medicine, University of RegensburgInstitute for Medical Epidemiology, Biometrics, and Informatics, Interdisciplinary Center for Health Sciences, Martin Luther University Halle-WittenbergInstitute for Community Medicine, University Medicine GreifswaldInstitute for Medical Epidemiology, Biometrics, and Informatics, Interdisciplinary Center for Health Sciences, Martin Luther University Halle-WittenbergInstitute of Medical Biometry and Epidemiology, University Medical Center Hamburg-EppendorfMolecular Epidemiology Research Group, Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC)Junior Professorship for Sociology, esp. Work and Health, Department of Sociology, University of BambergInstitute for Medical Informatics, Biometry and Epidemiology, University Hospital of EssenMolecular Epidemiology Research Group, Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC)Institute for Community Medicine, University Medicine GreifswaldInstitute of Medical Biometry and Epidemiology, University Medical Center Hamburg-EppendorfInstitute of Medical Sociology, University Medical Center Hamburg-EppendorfInstitute of Medical Sociology, University Medical Center Hamburg-EppendorfAbstract Background The educational gradient in depressive symptoms is well documented. Gender and history of migration have also been found to be associated with depressive symptoms. Intersectional approaches enable the analysis of the interplay of different social factors at a time to gain a deeper understanding of inequalities in depressive symptoms. In this study, intersectional inequalities in depressive symptoms according to education, gender and history of migration are analysed. Methods The German National Cohort (NAKO, N = 204,783) collected information on depressive symptoms (PHQ-9), which was used as an outcome variable. Educational attainment (ISCED-97), gender, and history of migration constituted the different social strata in the analyses. The predicted probabilities of depressive symptoms for 30 social strata were calculated. Multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) was applied, using logistic regression and social strata were introduced as higher-level unit interaction terms. Results The analyses revealed an educational gradient in depressive symptoms, with differences within each educational group when gender and history of migration were introduced to the models. The predicted probabilities of depressive symptoms varied between the most advantaged and the most disadvantaged social strata by more than 20% points. Among the three studied variables, education contributed the most to the variance explained by the MAIHDA models. The between-strata differences were largely explained by additive effects. Conclusions We observed a robust educational gradient in depressive symptoms, but gender and history of migration had substantial contribution on the magnitude of educational inequalities. An intersectional perspective on inequalities in depressive symptoms enhances current knowledge by showing that different social dimensions may intersect and contribute to inequalities in depressive symptoms. Future studies on inequalities in depression may greatly benefit from an intersectional approach, as it reflects lived inequalities in their diversity.https://doi.org/10.1186/s12939-025-02479-2German national cohortNAKOIntersectional analysisEducational inequalitiesDepressionHistory of migration |
| spellingShingle | Nico Vonneilich Heiko Becher Klaus Berger Patricia Bohmann Hermann Brenner Stefanie Castell Nico Dragano Volker Harth Stefanie Jaskulski André Karch Thomas Keil Lilian Krist Berit Lange Michael Leitzmann Janka Massag Claudia Meinke-Franze Rafael Mikolajczyk Nadia Obi Tobias Pischon Marvin Reuter Börge Schmidt Ilais Moreno Velásquez Henry Völzke Christian Wiessner Olaf von dem Knesebeck Daniel Lüdecke Depressive symptoms, education, gender and history of migration - an intersectional analysis using data from the German National Cohort (NAKO) International Journal for Equity in Health German national cohort NAKO Intersectional analysis Educational inequalities Depression History of migration |
| title | Depressive symptoms, education, gender and history of migration - an intersectional analysis using data from the German National Cohort (NAKO) |
| title_full | Depressive symptoms, education, gender and history of migration - an intersectional analysis using data from the German National Cohort (NAKO) |
| title_fullStr | Depressive symptoms, education, gender and history of migration - an intersectional analysis using data from the German National Cohort (NAKO) |
| title_full_unstemmed | Depressive symptoms, education, gender and history of migration - an intersectional analysis using data from the German National Cohort (NAKO) |
| title_short | Depressive symptoms, education, gender and history of migration - an intersectional analysis using data from the German National Cohort (NAKO) |
| title_sort | depressive symptoms education gender and history of migration an intersectional analysis using data from the german national cohort nako |
| topic | German national cohort NAKO Intersectional analysis Educational inequalities Depression History of migration |
| url | https://doi.org/10.1186/s12939-025-02479-2 |
| work_keys_str_mv | AT nicovonneilich depressivesymptomseducationgenderandhistoryofmigrationanintersectionalanalysisusingdatafromthegermannationalcohortnako AT heikobecher depressivesymptomseducationgenderandhistoryofmigrationanintersectionalanalysisusingdatafromthegermannationalcohortnako AT klausberger depressivesymptomseducationgenderandhistoryofmigrationanintersectionalanalysisusingdatafromthegermannationalcohortnako AT patriciabohmann depressivesymptomseducationgenderandhistoryofmigrationanintersectionalanalysisusingdatafromthegermannationalcohortnako AT hermannbrenner depressivesymptomseducationgenderandhistoryofmigrationanintersectionalanalysisusingdatafromthegermannationalcohortnako AT stefaniecastell depressivesymptomseducationgenderandhistoryofmigrationanintersectionalanalysisusingdatafromthegermannationalcohortnako AT nicodragano depressivesymptomseducationgenderandhistoryofmigrationanintersectionalanalysisusingdatafromthegermannationalcohortnako AT volkerharth depressivesymptomseducationgenderandhistoryofmigrationanintersectionalanalysisusingdatafromthegermannationalcohortnako AT stefaniejaskulski depressivesymptomseducationgenderandhistoryofmigrationanintersectionalanalysisusingdatafromthegermannationalcohortnako AT andrekarch depressivesymptomseducationgenderandhistoryofmigrationanintersectionalanalysisusingdatafromthegermannationalcohortnako AT thomaskeil depressivesymptomseducationgenderandhistoryofmigrationanintersectionalanalysisusingdatafromthegermannationalcohortnako AT liliankrist depressivesymptomseducationgenderandhistoryofmigrationanintersectionalanalysisusingdatafromthegermannationalcohortnako AT beritlange depressivesymptomseducationgenderandhistoryofmigrationanintersectionalanalysisusingdatafromthegermannationalcohortnako AT michaelleitzmann depressivesymptomseducationgenderandhistoryofmigrationanintersectionalanalysisusingdatafromthegermannationalcohortnako AT jankamassag depressivesymptomseducationgenderandhistoryofmigrationanintersectionalanalysisusingdatafromthegermannationalcohortnako AT claudiameinkefranze depressivesymptomseducationgenderandhistoryofmigrationanintersectionalanalysisusingdatafromthegermannationalcohortnako AT rafaelmikolajczyk depressivesymptomseducationgenderandhistoryofmigrationanintersectionalanalysisusingdatafromthegermannationalcohortnako AT nadiaobi depressivesymptomseducationgenderandhistoryofmigrationanintersectionalanalysisusingdatafromthegermannationalcohortnako AT tobiaspischon depressivesymptomseducationgenderandhistoryofmigrationanintersectionalanalysisusingdatafromthegermannationalcohortnako AT marvinreuter depressivesymptomseducationgenderandhistoryofmigrationanintersectionalanalysisusingdatafromthegermannationalcohortnako AT borgeschmidt depressivesymptomseducationgenderandhistoryofmigrationanintersectionalanalysisusingdatafromthegermannationalcohortnako AT ilaismorenovelasquez depressivesymptomseducationgenderandhistoryofmigrationanintersectionalanalysisusingdatafromthegermannationalcohortnako AT henryvolzke depressivesymptomseducationgenderandhistoryofmigrationanintersectionalanalysisusingdatafromthegermannationalcohortnako AT christianwiessner depressivesymptomseducationgenderandhistoryofmigrationanintersectionalanalysisusingdatafromthegermannationalcohortnako AT olafvondemknesebeck depressivesymptomseducationgenderandhistoryofmigrationanintersectionalanalysisusingdatafromthegermannationalcohortnako AT danielludecke depressivesymptomseducationgenderandhistoryofmigrationanintersectionalanalysisusingdatafromthegermannationalcohortnako |