Socioeconomic status and depression—a systematic review

Abstract Low socioeconomic status (SES) has been associated with an increased risk of depression and psychiatric disorders in general. In this systematic review and meta-analysis, we provide an estimate of the risk of clinical depression associated with low SES across cultures, age groups, and study designs. Finally, we tested whether associations between SES and depression differed by the income of the country in which the study was conducted. A literature search across 5 databases returned 7943 studies. Title, abstract, and full-text screening resulted in 162 included studies of which 122 were meta-analyzed, 22 were included in a cross-sectional narrative review, and 19 studies were included in a longitudinal narrative review. Meta-analyses were divided into risk estimates for composite SES, income, education, and employment. Sensitivity analyses based on differences in economic situation in the country of study origin were performed to investigate a possible source of between-study heterogeneity. Low SES was associated with an increased risk of depression across all measures of SES. Low income was associated with the highest odds ratio for depression (1.96; 95% CI, 1.53-2.52). Sensitivity analyses revealed no significant differences in between-study heterogeneity or risk of depression between high- and low-income economy groups. Comparable risks of depression across economy groups suggest that income relative to your peers, rather than absolute income, is a risk factor for depression. Preventive measures and possible policy interventions are discussed.