Attainment as a Means to Fight Depression

Poor mental health is a major burden of disease in Europe. The cost to society is substantial and is estimated to increase as the population ages. A high level of education is associated with better health and greater longevity both in developed and developing countries, but little research has been done on mental health and depression. An instrumental variable framework is used in conjuction with data collected through the third edition of the European Social Survey to estimate the impact of school attainment on depression in 23 countries across Europe. The results indicate a significant relationship between higher education level and better mental health. The magnitude of this relationship is small but not negligible. Increasing the overall education among new generations is not likely to substantially prevent the occurrence of mental disorders in a country but can mitigate it. The results of the analysis suggest that other factors, such as employment and living with a partner, might help reduce the risk of depression. Mental health is currently one of the biggest public health issues facing every country in Europe, affecting at least one in four people at some time in their lives. Out of 870 million people living in the European region, at any one time about 100 million people are estimated to suffer from anxiety or depression (World Health Organization [WHO], 2005). Neuropsychiatric disorders are the second greatest cause of the burden of disease after cardiovascular diseases. They account for 19.5 percent of all disability-adjusted life-years (DALYs, i.e., years lost to ill health and premature death). Depression alone is the third greatest cause, accounting for 6.2 percent of all DALYs, and the number of people with these disorders is likely to increase further as the population ages. Moreover, in many countries, mental health problems account for 35 to 45 percent of absenteeism from work (WHO, 2005). The economic costs to society of poor mental health is enormous; the International Labor Organization cautiously estimates that the cost of mental disorders account for 3 to 4 percent of the gross national product in the member states of the European Union (Gabriel & Liimatainen, 2000). Too often, the widespread stigma attached with mental health problems jeopardizes the development and implementation of mental health policies. Only recently have governments began to recognize the importance of mental well-being for all citizens. Mental wellbeing is fundamental to one’s quality of life, and given the large costs to society, policies reducing the risk of mental illness would likely have large private and social returns. Education is the most consistent indicator that shows a significant relationship between different measures of health and mortality. A high level of education has often been shown to be associated with better health and greater longevity (Cutler et al., 2006, 2008). Education affects health outcomes through several mechanisms. The main argument is that education, through the enhancement of knowledge and skills, enables individuals to adopt a healthier lifestyle and more coherent health-related behaviors (e.g., less tobacco and alcohol consumption). Moreover, education improves problem-solving abilities and, in turn, increases the possibility to access information about new medical technologies (Grossman, 1972, 2000, 2005; Smith, 2007). Another mechanism has also been widely studied: higher levels of schooling might be associated with more favorable psychosocial attributes and greater ability to deal with acute and chronic stress (Lantz et al., 2005; Ross & Wu, 1995; Schnittker & McLeod, 2005). A large body of literature has estimated that there is a large association between education and various health outcomes, yet mental health has been largely ignored. Estimating the effect of education on mental health is an important policy issue. It has the potential to reduce the social costs of depression, to show the great return from investing in education, and to provide the necessary rationalization for scaling up the delivery of education (Chevalier & Feinstein, 2007). Mental health has been conceptualized by the WHO as a state of well-being in which the individual realizes his or her own abilities, copes with the normal stresses of life, works productively and fruitfully, and makes a contribution to his or her community. The main difficulty in addressing mental health is the measurement issue. Self-reported measures of depression are problematic because individuals may misreport or underreport their status because of the fear of stigma or a lack of awareness of their own mental health status. Measurement error will bias the estimates of the returns to education if the measurement is not independent of the individual’s educational attainment. This study estimates the effect of education on mental health using information collected in the European Social Survey (ESS), administered in 2006 in 24 countries that are part of the European region. This relationship is explored using instrumental variables. The parental education levels are used as instruments in this study because of the possible endogeneity of the respondents’ education relative to their mental health as will be discussed below. The ESS is a cross-sectional survey, and the attempt to establish a causal link between education and depression could be better investigated if longitudinal data were available. However, it is possible to shed some light on the theoretical arguments behind this relationship. This paper is organized as follows. Section two includes an overview of the background literature, section three consists of the discussion of the data used in the analysis and the two-stage least square model, section four has the discussion of the results, and final thoughts and conclusions are found in section five. Background There is limited evidence on the effect of educational attainment on mental health. Depression has been associated mainly with genetic characteristics (Zubenko et al., 2003), childhood environment and prior history (Lewinsohn et al., 1998), age and gender. Depressive symptoms seem to increase with age as a result of an increased prevalence of disability and poor physical health. Moreover, women report, on average, higher levels of self-reported depressive problems in comparison to men. Biological explanations might be found in premenstrual hormone fluctuations as well as postmaternity-related depression and mental disorders, and especially among young mothers (Liao, 2003). Years of schooling and the level of education have been rarely studied as major causes of mental health, but these are important variables to take into consideration. Similar to other health outcomes, the effect of education on depression can be direct or can be established through an indirect channel. For example, education might be associated with other variables (e.g., income or occupation) that influence individuals’ mental health. Increasing the years of schooling may help train people in decision making, problem solving, perseverance, and adaptive skills, all of which are important in coping with stress and reducing the risk of developing depressive illnesses. However, it is possible that more qualified individuals report fewer mental health problems because of the links between education, occupation, and income. Education increases the probability of achieving a higher occupational grade and higher earnings, which conceivably can lead to greater access to better health care, more control over the working life, and more varied, hard work. All of these factors could be the basis of a lower level of depression (Chevalier & Feinstein, 2007). Furthermore, education reduces the probability of unemployment and divorce, which are two important sources of stress (Jalovaara, 2004). Many difficulties, consequently, are encountered when trying to estimate the influence of education on mental health. Reverse causality can play a role in this relationship: noncognitive skills such as attention and self-esteem, which are associated with higher mental health, have been found to have an impact on educational attainment (Heckman et al., 2006). The context in which people live and grow up cannot be disregarded when addressing depression and anxiety. Geography by itself can have a significant role in determining the onset of depression, given its influence on lifestyles, values, and weather conditions (Costa-Font & Gil, 2006). Additionally, the socioeconomic development of a country can explain the overall level of depression as a result of the accessibility to mental health care and level of stigmatization of the phenomenon. A third variable bias can also be found concerning childhood environment. Children living in a stable environment with one or both parents working and with a solid family background experience favorable conditions in the growing process. They are more likely to achieve greater education levels and are less likely to develop mental disorders or depression. However, studies addressing European countries do not agree on the effect of education on depression. Costa-Font and Gil (2006) analyzed the degree of socioeconomic inequality in reported depression in Spain. They found evidence of a significant role of education in determining socioeconomic inequalities in diagnosed depression, which may explain why equality of income would not solve the problem. Another study focusing on the United Kingdom found that education significantly reduces the risks of adult depression, especially among women, even if the effect is nonlinear and is larger at lowto mid-levels of education (Chevalier & Feinstein, 2007). According to their results, having a secondary education qualification in Britain appears to reduce the risk of adult depression (age 42) by 5 to 7 percent. Using a longitudinal study, the authors were able to study the causal effect of schoo