Depression among adolescents and young adults : social and gender differences

Depression is a large public health problem that has a negative impact on many aspects of life. Among adolescents and young adults it is the leading cause of disability-adjusted life years. Many different factors can be expected to play a role in its development, such as biology, physical disease, gender, and psychosocial and socioeconomic factors. Depression is more common among women than among men; however, it constitutes a large public health problem also for men though less attention has been given to them. Much previous research shows that there are social differences in poor mental health. The field is however hampered by the use of different definitions and measurements such as the omnibus measure of “psychological distress”, as well as little focus on specific mental disorders, young age and gender, especially in welfare states typical of the Nordic countries. The overall aim with this thesis was thus to expand upon previous research and enhance the knowledge about social and gender differences in depression among young people in Sweden. Three different materials were used to capture a broad picture of the role of social position, gender and depression, in adolescence (13-17 year olds) and in young adulthood (18-32 year olds). 1) Longitudinal survey data from the BROMS cohort was used to assess the risk of self-reported depressive symptoms by different social factors (study I). 2) Register data from the Stockholm Youth Cohort was used to assess the risk of diagnosed depression in different social groups by using a large study population and a cohort design (study II). The register data was further used to investigate social differences in psychosocial functioning and psychiatric comorbidity among adolescents with depression (study III). 3) Data from qualitative interviews was used to explore how young men experience depression and helpseeking in relation to their conception of masculinity (study IV). The results from this thesis show that low social position in childhood increases the risk of depression in adolescence, and of a more burdensome depression (worse psychosocial functioning and/or psychiatric comorbidity) amongst adolescents with depression. The social differences were more evident in self-reported depressive symptoms compared to diagnosed depression, and in a more burdensome depression (among adolescents with depression) compared to depression only. Among adolescents with foreign-born parents there was a lower risk of diagnosed depression but no differences were found in self-reported depressive symptoms as compared to having Swedish born parents. Girls had an increased risk of both self-reported depressive symptoms and diagnosed depression compared to boys. Gender differences in relation to social position in diagnosed depression were small. However, girls with parents with low education were found to be particularly vulnerable to both self-reported and diagnosed depression as well as worse psychosocial functioning among those with depression. Both boys and girls with depression with lower familial social position faced an increased risk of psychiatric comorbidity but with differences in type of comorbidity between genders. The young adult men’s acceptance and help-seeking for depression was found to be delayed because of the perceived gender ideals. We thus highlight the importance of gender awareness among professionals as well as among those affected by depression. Continued efforts are needed to reduce social and gender differences in depression, particularly considering the fact that a great number of people are affected. Explanations to these social differences, and to social differences in care-seeking related to depression, need further attention. LIST OF SCIENTIFIC PAPERS The thesis is based on the following publications. In the text, they will be referred to by their Roman numerals. I. Wirback, T. , Möller, J., Larsson, J-O. , Galanti, MR., & Engström, K. Social factors in childhood and risk of depressive symptoms among adolescents – a longitudinal study in Stockholm, Sweden. International Journal for Equity in Health 2014, 13:96 II. Wirback, T. , Möller, J., Larsson, J-O. , & Engström, K. Social differences and diagnosed depression among adolescents in a Swedish population based cohort. BMC Psychiatry 2018, 18:216 III. Wirback, T. , Möller, J., Larsson, J-O. , Engström, K. Social differences in psychiatric comorbidity and psychosocial functioning among adolescents with depression. Manuscript IV. Wirback, T. , Forsell, Y. , Larsson, J-O. , Engström, K. , & Edhborg, M. Experiences of Depression and Help-Seeking Described by Young Swedish Men. Psychology of Men & Masculinity 2018, 19(3), 407-417