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Chiyoe Murata, PhD, MPH, Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192, Japan, 81-53-435-2333, cmurata@hama-med.ac.jp, Kiyoko Yoshii, MS, RN, Department of Social Welfare, Nihon Fukushi University, Okuda, Mihama-cho, Chita-gun, Aichi, 470-3295, Japan, Hiroshi Hirai, PhD, COE Promotion Office, Nihon Fukushi University, 5-22-35 Chiyoda, Naka-ku, Nagoya, 460-0012, Japan, and Katsunori Kondo, PhD, MD, Department of Health Welfare, Nihon Fukushi University, Okada, Mihama-cho, Chita-gun, Aichi, 470-3295, Japan.

Background: Depression is associated with disability onset, illnesses, sleeping problems, and even with suicide among the elderly. Various studies reported association of depression with lower SES (socio-economic status). However, such association is less clear in Japan. Methods: To investigate if social gradient of depression is observed in Japan, we conducted a questionnaire survey with functionally independent elderly in 15 municipalities (6 urban, 2 semi-urban, and 7 rural) in 2003. Overall, 32,891 elders completed the survey. Depression was assessed using GDS-15 with a cutoff point of 4/5 for mild depression. SES was measured in terms of years of education (<6, 6-9, 10-12, 13+) and household income (low, middle, high). Results: Percentages of the mildly depressed elderly were significantly higher for low SES (47.8% and 25.0% for <6 and 13+ years of education: 45.2% and 23.0% for low and high income, respectively) in age adjusted ANOVA. After adjustment for age, area of residence, illnesses, IADL, sex, and self-rated health, depression was still significantly associated with lower SES with odds ratios of 1.4 for <6 vs. 13+ years of education (p<.01) and 2.4 for low vs. high income (p<.001) in multiple logistic regression analyses. Conclusions: Higher rate of mild depression was observed among the lower SES elders in Japan even after adjusting for possible confounders. Moreover, rural elders had a significantly higher rate of depression, suggesting possible area differences in the health of the elderly.

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