Mental Health Across Europe

Liam has been posting recently about mental health. One source of data on this is international surveys which allow cross country comparisons. Share is especially useful in this regard. The following graph demonstrates that there is a considerable amount of variation in Europe with respect to depressive symptoms. This index is derived from 12 binary variables measuring the presence or absence of the following: depression, pessimism, wishing death, guilt, sleeplessness, disinterest, irritability, loss of appetite, fatigue, lack of concentration, lack of enjoyment, and tearfulness. The EURO-D scale has been previously validated (Prince et al., 1999), and seems like it should be less susceptible to the usual problems associated with self assessments as it directly measures the presence of these symptoms. I have just pooled the data from the first two waves and some countries are in here only once, and I have ordered the countries in the sample according to the mean of this scale. Nevertheless, the spread is pretty striking. At the individual level anything above 3 is potentially indicative of clinical levels of depression, which is very worrying for Italy, Israel, Spain and Poland. One explanation for these differences relates to the prevalence of different types of social networks, a topic I will post about again at some stage.

Of course this is before the recession. Angus Deaton’s paper on wellbeing and the financial crisis has already been mentioned here.

IZA Working Paper: A Guide and Advice for Economists on the U.S. Junior Academic Job Market

IZA DP No. 5984

John Cawley:

A Guide and Advice for Economists on the U.S. Junior Academic Job Market (2011-2012 Edition)

Abstract:
This guide, updated for the 2011-12 job market season, describes the U. S. academic market for new Ph.D. economists and offers advice on conducting an academic job search. It reports findings from published papers, describes practical details, and provides links to internet resources. Topics addressed include: preparing to go on the market, applying for academic jobs, signaling, interviewing at the ASSA meetings, campus visits, the secondary market scramble, offers and negotiating, diversity, and dual job searches.

http://ftp.iza.org/dp5984.pdf

Prayer can reduce depression: some econometric evidence

There has been a lot of work in recent years by economists on the determinants of people’s well-being. Many of these determinants are not something you can do much about at least in the short run, like income or health.

In a paper in press in Social Science and Medicine I look at the effect of prayer on the number of symptoms of depression recorded by individuals in the previous month. The data is from the Survey of Health, Aging and Retirement in Europe (SHARE) . I use the Euro-D scale which was designed to measure the incidence of depression symptons in an older population – it is not a diagnostic scale.

There are many studies looking at associations between well-being or mental health and either religion affiliation or devotion. Freud took a rather dim view of religion and this has cast a long shadow on the issue. As far as I can see, he did not do any serious data analysis so its unclear to me why one should put any weight on his views.

A problem of course in this literature, is whether one can infer anything causal. After all, people who are feeling down might easily turn to religion as a response. I use instrumental variable estimation to tackle this issue.

This turns a positive association (prayer positively correlated with depression) to a negative one i.e. prayer reduces the number of depression symptoms. This is not that surprising in a sense: if prayer made you more miserable on average, you would have an incentive not to do it. The results are robust to various combinations of instruments.

The magnitude of the effect (of praying at least daily) is comparable to that associated with different marital statuses, about half that of being female and twice as big as the effect of being unemployed.

I speculate on the possible mechanisms behind this effect, noting that it may not be the religious aspect per se. There is increasing evidence of the benefits of meditition and mindfulness based techniques for reducing depression and anxiety.

Prediction is difficult, especially if you are depressed

A well known quip holds that “Prediction is difficult, especially about the future”. It is attributed to various people including Yogi Berra, Niels Bohr and, for all I know, Yogi Bear too. Nonetheless it has been widely observed that people are often pretty bad at making predictions. This is bad news for those economists who believe in the Rational Expectations hypothesis. Although they will probably say they expected to hear that.

So what factors might cause people to predict badly? In a new study, from INSEAD, researchers find that depressed individuals are particularly bad at prediction. The subjects consisted of 1,100 soccer fans asked to forecast how teams progressed in various competitions. In particular depressed people tend to over-weight unlikely events. So if you are a depressed individual and an Arsenal fan (and you can see why those two would go together) be prepared for disappointment.

The negative effect of height on well-being: a tall story?

Height and well-being amongst older Europeans
Kevin Denny

This paper uses a cross-country representative sample of Europeans over the age of 50 to analyse whether individuals’ height is associated with higher or lower levels of well-being. Two outcomes are used: a measure of depression symptoms reported by individuals and a categorical measure of life satisfaction. It is shown that there is a concave relationship between height and symptoms of depression. These results are sensitive to the inclusion of several sets of controls reflecting demographics, human capital and health status. While parsimonious models suggest that height is protective against depression, the addition of controls, particularly related to health, suggests the reverse effect: tall people are predicted to have slightly more symptoms of depression. Height has no significant association with life satisfaction in models with controls for health and human capital.

Here also

Mindfulness, meditation and mental health

Some researchers have advocated the use of mindfulness based techniques to deal with affective disorders, for example there is an RCT that finds it effective against depression for women with fibromyalgia and also evidence of how meditation can help anxiety, stress or agoraphobia.
Closer to home, the Northern Ireland Health Service has brought in a Buddhist monk to provide mindfulness based "happiness classes". I don't know how accurate a description that is but Sammy Wilson MP is not a happy bunny.

The height of depression?

A number of studies have suggested that a person's height is associated with depression with taller people being less likely to be depressed. This effect, if it exists, could be reactive whereby the individual experiences low self-esteem or perhaps bullying as a result of their low stature. Alternatively short stature could be a marker for poor early life conditions. The evidence seems unclear overall.
So what if anything can we tell from the Growing Up in Ireland data? Below I graph a depression index (for the main carer in the study) against their height, adjusting for age, household income and whether there is a partner in the house. This is not a random sample of the population remember: all of the respondents (i.e. the main carers) have a child in the study (most of whom are 8 years old) & almost all are female i.e. they are typically the mother.
While it may not be obvious there is indeed a slight gradient: taller people do have a lower depression score. The association is small: on average one additional centimetre in height is associated with a reduction in the depression score of .005 (half of one percent) of a standard deviation. So while it is statistically significant, arguably it is not significant otherwise.
To put things in context having a partner in the house has approximately one hundred times the effect of an additional cm in height (i.e. half a standard deviation), so hang onto your man, I guess.

Religious belief, devotion and well-being

Recently my thoughts turned to God, well religion. The fact that I was high in the sky (literally and neither metaphorically nor narcotically) may have had something to do with it. Some people have claimed that there are significant benefits to either being religious or to religous devotion (i.e. prayer). I think the Iona Institute published something on this a while back and I'm pretty sure that I was skeptical for a number of reasons, the most obvious one being that the results cited were just correlations rather than causal. To me, there is something rather profane about arguing the case for religion on the basis that it benefits you in this life. That said, several evangelists claim that God wants you to be rich and, if you buy their book, you will find out how (including "economist/entrepreneur/professor Paul Zane Pilzer"). But, nevertheless, if there are such benefits, they are scientifically interesting.

Leaving aside issues of causality for the moment, I thought it useful to examine the association between several measures of well-being and two measures of religion whether one is a believer and frequency of prayer. Without making any great claims, this is a bit more sophisticated than some studies I have seen.
The results below show a curious pattern. Both frequency of prayer and being a believer are positively associated with an ordinal measure of life satisfaction.
However using a measure of depression (the Euro-d scale) there is a paradox: believers are likely to have lower levels of depression (consistent with the first result, perhaps) but those who pray often are more likely to have depression. Curious, isn't it?
Of course life satisfaction and depression are not the same so we should not expect them to necessarily display the same patterns. It may be the case that endogeneity/reverse causality has something to do with this: perhaps depression drives you to pray more often. But then why not low life satisfaction also?
I have been done some work controlling for endogeneity with interesting results but what they are I am not going to tell you. All I will say is it beat the in-flight movie. Keep the faith, whatever that is.


............Satisfied (1-4). Depression (0-10)

pray-often: 0.0129* . 0.0830***

believer : 0.147*** . -0.275***


1st model is an ordered probit, 2nd model is an OLS regression

controls:age,marital status,education,height, cognitive ability,country effects
n=15,275. Data=SHARE.
Apologies for the lousy formatting.

Height and depression: continued

Further to my post ("Some unpleasant anthropometric arithmetic") below, I show simple Tobits of the malaise score against height but split by sex. The effect is much bigger for women: being short and female is particularly bad.
I have replicated this with the SHARE data and the results are qualitatively similar but much smaller in magnitude. So if the effect is "psychological" (i.e. due to stigma say & not just a marker for some other factor) is it that women are more emotionally sensitive to being of low stature?

Malaise @ 23, Tobit estimator

	(1)	(2)
	men	women
model
height23	-3.989***	-5.897***
	(6.11)	(8.11)
_cons	8.331***	12.59***
	(7.20)	(10.67)
sigma
_cons	3.408***	3.732***
	(84.24)	(96.88)
N	6191	6211

Absolute t statistics in parentheses

^* p <>** p <>*** p <>

Some unpleasant anthropometric arithmetic

Patterns in- and correlates of- height is something that has featured in this blog regularly. Seeing this is the New Year I thought I would start with a good new story.
The graph below is a kernel regression of "malaise" a measure of low mood (due to Rutter I think) & height, measured at age 23. So great news if you are tall...
Patterns such as this have been noticed before (refs below) but knowing how to interpret it is trickier. Is it because of stigma or prejudice - remember the (in)famous Randy Newman song? Or is it a marker for bad early life conditions à la Barker perhaps? I don't know, off hand, how one might distinguish between these two hypotheses.

Martel L.F. & H.B. Biller (1987) Stature and Stigma Lexington: Lexington Press
Stack S. & I. Wasserman (1996) Height and risk of suicide Journal of Social Psychology

Unemployed, Depressed and Spreading Loneliness

People who have recently become unemployed are four times more likely to claim to have depression than the general population, a new survey suggests. The survey is the Pfizer Health Index; this year the study also examined the impact of the recession on people’s lives, with particular focus on those who recently became unemployed.

"The Pfizer Health Index is a Behaviour and Attitudes National Barometer Survey, which samples 1,040 adults aged 16 and over. Pfizer said a "booster" of 122 recently unemployed people was added to the research this year." See more here. More information is also available here. The 2008 report (related to the Pfizer Health Index) is available here.

Finally, the link between unemployment and depression is worth considering in light of new research which indicates that loneliness spreads in social networks: "Loneliness can be contagious, new study finds". The research, a new study in the Journal of Personality and Social Psychology, was led by John Cacioppo, a neuroscientist and psychologist at the University of Chicago. The data comes from a longitudinal study, conducted by the University of Chicago, the University of California-San Diego and Harvard, which interviewed more than 5,000 people over the course of 10 years, tracking their friendship histories and their reports of loneliness.

"In the study, researchers found that lonely individuals tend to move to the fringes of social networks (and, no, we’re not talking about Facebook or Twitter here), where they have fewer and fewer friends.

But before they move to the periphery, they “infect” or “transmit” their feelings of loneliness to their remaining friends. With fewer close relationships, these friends then become lonely and eventually move to the fringes of the social network, again passing their loneliness on to others. Thus, the cycle continues."

The study also found that "loneliness spreads much more easily among women than among men, citing the idea that women may be more likely to express and share emotions, as well as the observation that there may be greater stigma associated with loneliness among men." This may be the source of some solace: the latest Live Register (LR) figures show that almost twice as many men are claiming unemployment benefit (or allowance), compared to women. If two-thirds of LR claimants (i.e. the males) are less likely to spread their feelings of loneliness (compared to the other third), then this is the potential source of solace. However, there is still the possibility that loneliness could be spreading; and more importantly; LR claimants are more likely to be depressed.

A non-benefit from education?

There is quite body of research looking at the effects of education on health. Generally these papers look at physical health and find a positive relationship. This one looks at mental health and finds no effect.
Does Education Shield Against Common Mental Disorders?
Edvard Johansson,Petri Böckerman,Tuija Martelin,Sami Pirkola,Karí Poikolainen
The paper examines the causal effect of education on common individual mental disorders in adulthood. We use a representative population health survey and instrumental variable methods. The estimates point to mostly insignificant effects of education on common mental disorders. We find that the length of education reduces the BDI (Beck Depression Inventory) measure at the 10% significance level, but has no effect when using the GHQ-12 (12-item General Health Questionnaire) or the probability of severe depression as a measure of mental health. These results cast doubt on the view that the length of formal education would be a particularly important determinant of common mental disorders later in life.
http://www.etla.fi/files/2380_Dp1202.pdf

Gallup on Exercise, BMI & Depression

I'm not sure we need 250,000 interviews to tell us this but interesting nonetheless:



It's worth noting that exercise without weight loss has been proposed as a successful way to intervene in obesity (body composition but not weight changes):


Potentially more interesting is the finding that there doesn't appear to be a linear relationship between exercise and the likelihood of depression with those exercising 7 days a week having a higher rate of depression than those exercising 3-4 or 5-6 days and around the same as those exercising 1-2 days (more here).

Height, happiness and all that

Angus Deaton has a nice recent piece on height & well being.
http://www.princeton.edu/~deaton/downloads/life_at_the_top_benefits_of_height_final_june_2009.pdf

As an exercise I plot, from SHARE, the relationship between Depression (the EUROD scale) and height (in cm.) for men & women separately. The gradient is noticeably steeper for females and is flat at high levels.

Substance P at the nexus of mind and body in chronic inflammation and affective disorders

A potentially very interesting serum marker: For decades, research has demonstrated that chronic diseases characterized by dysregulation of inflammation are particularly susceptible to exacerbation by stress and emotion. In recent years, substance P has been implicated in both the pathophysiology of inflammatory disease and the pathophysiology of depression and anxiety by 2 parallel fields of study. This review integrates the literature from these 2 parallel fields and examines the possibility that substance P dysregulation may be a point of convergence underlying the overlap of chronic inflammatory disease and mood and anxiety disorders.

Abstract, Full