Aging, Health Behaviors, and Health Outcomes

By K. Warner Schaie; Dan Blazer et al. | Go to book overview

Statistical and Causal Interaction in the Diagnosis and Outcome of Depression

Carmi Schooler National Institute of Mental Health

The research reported by George in chapter 5 answers important questions about how social-structural factors interact with age to affect the onset and outcome of depression. It does so by carrying out sensible analyses of state-of-the- art interview data gathered from a sophisticatedly selected representative sample of individuals in the community. It also uses similarly sophisticated methods to examine the course of illness of a reasonably representative sample of patients hospitalized for the treatment of major depression.

George's results point to several interesting conclusions: Age may moderate the effects of various social factors on depression--being female, urban, Black, poorly educated, and physically ill increases the chances of becoming depressed at younger, but not older ages. On the other hand, being married, which is not related to depression among young adults, is associated with a decreased likelihood of depression among middle-aged and older adults. Marital status has an intriguingly different relationship to recovery from depression among older adults. In this population, being married, and also having a large social network decreased the chance of recovering after hospitalization.

Although ultimately convincing, George's analyses and findings raise important methodological and substantive issues. In this chapter, I begin by discussing a few methodological qualms I have about the specific analyses carried out. These qualms reflect more general concerns about what I see as problematic in much of the research linking psychiatric epidemiology to social factors. In doing so, I focus on a methodological issue--the importance of considering interactions in epidemiological research--that I have discussed previously in the context of cross-cultural research on schizophrenia (. Schooler, 1989), but which is equally relevant to research on depression, social structure, and the

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