Parameters of education and the course of depression: An analysis in the Turkish sociocultural context

Background: Major depression (MD) is often marked by an unfavourable course. Education repeatedly was found to be associated with better mental health variables, but longitudinal data are scarce. This evaluation seeks to identify the predictive role of specific aspects of education on the course of depression in a socioculturally defined setting. Methods: A sample of 69 unipolar MD outpatients in university and primary health care in Antalya, Turkey were observed naturalistically for a mean 11-month period. The baseline examination included several psychosocial variables, among them the highest attained schooling degree (DEG), possible further but unfulfilled educational aspirations (UEA), and the participants' parental educational level (PEL). The depressive symptomatology was assessed with the HAM-D-17 at baseline and at four-monthly follow-ups. A binary variable differentiated non-remissive' from remissive' courses, the latter displaying at least temporal partial remissions. Results: Forty-two per cent of the sample displayed a non-remissive one-year course of MD. Half of the participants reported UEA. This was more prevalent among women, and qualitative information added causal gender-specific perceptions. In logistic regression, DEG proved prognostic impact, but was exceeded by the combination of UEA and PEL as the strongest predictor model (Cox & Snell R-2 = 0.217). This remained when controlled for place of examination, gender and initial severity of depression. As risk factors for low education, a pattern of female gender and large family size (itself predicted by rural descent) emerged. Conclusions: Low education proved to be a risk factor for an unfavourable course of MD. Not only actual experienced schooling, but also unfulfilled academic aspirations and a low parental educational level appear to be of crucial impact.