{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T10:36:33Z","timestamp":1774002993521,"version":"3.50.1"},"reference-count":42,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2017,12,27]],"date-time":"2017-12-27T00:00:00Z","timestamp":1514332800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000002","name":"NIH","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Inequalities in the distribution of self-reported health (SRH) have been widely reported. Its higher expressivity among women, elderly and least educated groups has been partly attributed to differences in their health perceptions. However, this subjectivity may be masking the burden of mental illness in these groups. Thus, we sought to understand if depression symptoms mediate inequalities in SRH.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>SHARE waves 4 and 6, pertaining to Spain, Italy and Portugal, were used (n2011 = 8517, n2015 = 11 046). Inequalities in SRH were calculated, comparing the risk amongst education level, gender and age groups, adjusting for chronic diseases, functional limitations and country fixed effects. We then tested depression symptoms as mediators.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Depression symptoms were associated with poor SRH (odds ratio (OR)2011 = 1.379, OR2015 = 1.384, P &lt; 0.001). Their inclusion reduced the magnitude of the association between SRH and education, annulled the statistical significance for age, and reversed the gender effect. As expected, chronic diseases and functional limitations remained significant predictors of poor SRH.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Depression symptoms, together with chronic diseases and functional limitations, explain the poorer SRH of the least educated, female and older groups in the Southern European population. Therefore, tackling inequalities in SRH must require focusing on mental health issues, which disproportionately affect the most vulnerable groups.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/pubmed\/fdx173","type":"journal-article","created":{"date-parts":[[2017,11,27]],"date-time":"2017-11-27T07:12:21Z","timestamp":1511766741000},"page":"756-763","source":"Crossref","is-referenced-by-count":13,"title":["Depression symptoms as mediators of inequalities in self-reported health: the case of Southern European elderly"],"prefix":"10.1093","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7364-0100","authenticated-orcid":false,"given":"T","family":"Le\u00e3o","sequence":"first","affiliation":[{"name":"Escola Nacional de Sa\u00fade P\u00fablica, Universidade NOVA de Lisboa, Lisboa, Portugal"}]},{"given":"J","family":"Perelman","sequence":"additional","affiliation":[{"name":"Escola Nacional de Sa\u00fade P\u00fablica, Universidade NOVA de Lisboa, Lisboa, Portugal"},{"name":"Centro de Investiga\u00e7\u00e3o em Sa\u00fade P\u00fablica, Lisboa, Portugal"}]}],"member":"286","published-online":{"date-parts":[[2017,12,27]]},"reference":[{"issue":"11","key":"2019120301404114500_fdx173C1","doi-asserted-by":"crossref","first-page":"2281","DOI":"10.1016\/j.socscimed.2008.01.022","article-title":"Welfare state regimes and differences in self-perceived health in Europe: a multilevel analysis","volume":"66","author":"Eikemo","year":"2008","journal-title":"Soc Sci Med [Internet]"},{"issue":"7","key":"2019120301404114500_fdx173C2","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1136\/jech-2015-206780","article-title":"Trends in socioeconomic inequalities in self-assessed health in 17 European countries between 1990 and 2010","volume":"70","author":"Hu","year":"2016","journal-title":"J Epidemiol Community Health [Internet]"},{"issue":"2","key":"2019120301404114500_fdx173C3","doi-asserted-by":"crossref","first-page":"131","DOI":"10.2471\/BLT.09.067058","article-title":"Self-reported health assessments in the 2002 World Health Survey: how do they correlate with education?","volume":"88","author":"Subramanian","year":"2010","journal-title":"Bull World Health Organ"},{"key":"2019120301404114500_fdx173C4","author":"Eurostat"},{"issue":"5","key":"2019120301404114500_fdx173C5","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1016\/S0277-9536(02)00454-9","article-title":"Socioeconomic inequalities in morbidity among the elderly; a European overview","volume":"57","author":"Huisman","year":"2003","journal-title":"Soc Sci Med [Internet]"},{"issue":"9458","key":"2019120301404114500_fdx173C6","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1016\/S0140-6736(05)17867-2","article-title":"Educational inequalities in cause-specific mortality in middle-aged and older men and women in eight western European populations","volume":"365","author":"Huisman","year":"2005","journal-title":"Lancet"},{"key":"2019120301404114500_fdx173C7","author":"Marmot","year":"2010"},{"issue":"6","key":"2019120301404114500_fdx173C8","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1093\/eurpub\/ckr184","article-title":"Perception or real illness? How chronic conditions contribute to gender inequalities in self-rated health","volume":"22","author":"Malmusi","year":"2012","journal-title":"Eur J Public Health"},{"issue":"23","key":"2019120301404114500_fdx173C9","doi-asserted-by":"crossref","first-page":"2468","DOI":"10.1056\/NEJMsa0707519","article-title":"Socioeconomic inequalities in health in 22 European countries","volume":"358","author":"Mackenbach","year":"2008","journal-title":"N Engl J Med"},{"key":"2019120301404114500_fdx173C10","volume-title":"Health Inequalities: Europe in Profile [Internet]","author":"Mackenbach","year":"2006"},{"issue":"3","key":"2019120301404114500_fdx173C11","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1016\/0895-4356(94)00143-E","article-title":"Self-reported health and survival in the longitudinal study of aging, 1984\u20131986","volume":"48","author":"Grant","year":"1995","journal-title":"J Clin Epidemiol"},{"key":"2019120301404114500_fdx173C12","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1136\/jech.49.2.117","article-title":"International variation in socioeconomic inequalities in self reported health","volume":"49","author":"Kunst","year":"1995","journal-title":"J Epidemiol Community Heal"},{"issue":"8","key":"2019120301404114500_fdx173C13","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1093\/aje\/kwr204","article-title":"Reliability of self-rated health in US adults","volume":"174","author":"Zajacova","year":"2011","journal-title":"Am J Epidemiol"},{"issue":"12","key":"2019120301404114500_fdx173C14","doi-asserted-by":"crossref","first-page":"2339","DOI":"10.1590\/S0102-311X2012001400012","article-title":"Gender disparities in health and healthcare: results from the Portuguese National Health Interview Survey","volume":"28","author":"Perelman","year":"2012","journal-title":"Cad Saude Publica [Internet]"},{"key":"2019120301404114500_fdx173C15","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1192\/bjp.174.4.339","article-title":"Depression symptoms in late life assessed during the EURO-D scale. Effect of age, gender and marital status in 14 European centres","volume":"174","author":"Prince","year":"1999","journal-title":"Br J Psychiatry"},{"issue":"2","key":"2019120301404114500_fdx173C16","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1093\/aje\/kwf182","article-title":"Socioeconomic inequalities in depression: a meta-analysis","volume":"157","author":"Lorant","year":"2003","journal-title":"Am J Epidemiol [Internet]"},{"issue":"1","key":"2019120301404114500_fdx173C17","first-page":"45","article-title":"Depression among older people in Europe: the EURODEP studies","volume":"3","author":"Copeland","year":"2004","journal-title":"World Psychiatry [Internet]"},{"issue":"4","key":"2019120301404114500_fdx173C18","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1016\/S0895-4356(01)00491-7","article-title":"Self-rated health, chronic diseases, and symptoms among middle-aged and elderly men and women","volume":"55","author":"Molarius","year":"2002","journal-title":"J Clin Epidemiol"},{"issue":"7","key":"2019120301404114500_fdx173C19","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.1017\/S1041610214000611","article-title":"Coexisting medical comorbidity and depression: multiplicative effects on health outcomes in older adults","volume":"26","author":"Ho","year":"2014","journal-title":"Int Psychogeriatrics"},{"key":"2019120301404114500_fdx173C20","first-page":"1289","article-title":"Overview of the prevalence, impact, and management of depression and anxiety in chronic obstructive pulmonary disease","volume":"9","author":"Panagioti","year":"2014","journal-title":"Int J Chron Obs Pulmon Dis"},{"key":"2019120301404114500_fdx173C21","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1111\/j.1532-5415.1998.tb01011.x","article-title":"Functioning, well-being, and health perception in late middle-aged and older people: comparing the effects of depressive symptoms and chronic medical conditions","volume":"46","author":"Ormel","year":"1998","journal-title":"J Am Geriatr Soc"},{"key":"2019120301404114500_fdx173C22","author":"B\u00f6rsch-Supan","year":"2016"},{"issue":"2","key":"2019120301404114500_fdx173C23","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1377\/hlthaff.27.2.350","article-title":"The gap gets bigger: changes in mortality and life expectancy, by education, 1981\u20132000","volume":"27","author":"Meara","year":"2008","journal-title":"Health Aff"},{"issue":"1","key":"2019120301404114500_fdx173C24","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/s12888-015-0390-4","article-title":"Psychometric properties of EURO-D, a geriatric depression scale: a cross-cultural validation study","volume":"15","author":"Guerra","year":"2015","journal-title":"BMC Psychiatry [Internet]"},{"issue":"APR.","key":"2019120301404114500_fdx173C25","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1192\/bjp.174.4.330","article-title":"Development of the EURO-D scale\u2014a European Union initiative to compare symptoms of depression in 14 European centres","volume":"174","author":"Prince","year":"1999","journal-title":"Br J Psychiatry"},{"issue":"8","key":"2019120301404114500_fdx173C26","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1002\/gps.667","article-title":"The Geriatric Mental State Examination in the 21st century","volume":"17","author":"Copeland","year":"2002","journal-title":"Int J Geriatr Psychiatry"},{"key":"2019120301404114500_fdx173C27","author":"Torres-Reyna","year":"2007"},{"issue":"4","key":"2019120301404114500_fdx173C28","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1016\/j.socscimed.2012.02.031","article-title":"The persistence of health inequalities in modern welfare states: the explanation of a paradox","volume":"75","author":"Mackenbach","year":"2012","journal-title":"Soc Sci Med [Internet]"},{"issue":"3","key":"2019120301404114500_fdx173C29","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1093\/heapro\/6.3.217","article-title":"The concepts and principles of equity and health","volume":"6","author":"Whitehead","year":"1991","journal-title":"Health Promot Int [Internet]"},{"issue":"6","key":"2019120301404114500_fdx173C30","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1001\/archpsyc.1995.03950180083011","article-title":"The prevalence of dementia and depression in the elderly community in a Southern European Population. The Zaragoza Study","volume":"52","author":"Lobo","year":"1995","journal-title":"Arch Gen Psychiatry"},{"issue":"2\u20133","key":"2019120301404114500_fdx173C31","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/j.jad.2008.02.008","article-title":"Prevalence and risk factors for depression in non-demented primary care attenders aged 75 years and older","volume":"111","author":"Weyerer","year":"2008","journal-title":"J Affect Disord [Internet]"},{"key":"2019120301404114500_fdx173C32","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1016\/S0140-6736(07)61415-9","article-title":"Depression, chronic diseases, and decrements in health: results from the World Health Surveys","volume":"370","author":"Moussavi","year":"2007","journal-title":"Lancet"},{"issue":"1","key":"2019120301404114500_fdx173C33","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1093\/ageing\/afp187","article-title":"Health status and risk for depression among the elderly: a meta-analysis of published literature","volume":"39","author":"Chang-Quan","year":"2010","journal-title":"Age and Ageing [Internet]"},{"issue":"4","key":"2019120301404114500_fdx173C34","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1016\/0277-9536(95)00335-5","article-title":"Gender differences in health: are things really as simple as they seem?","volume":"42","author":"Macintyre","year":"1996","journal-title":"Soc Sci Med"},{"issue":"9995","key":"2019120301404114500_fdx173C35","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1016\/S0140-6736(15)60692-4","article-title":"Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990\u20132013: a systematic analysis for the Global Burden of Disease Study 2013","volume":"386","author":"Vos","year":"2015","journal-title":"Lancet [Internet]"},{"key":"2019120301404114500_fdx173C36","author":"Institute for Health Metrics and Evaluation","year":"2015"},{"key":"2019120301404114500_fdx173C37","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1007\/978-94-007-4276-5_14","volume-title":"Handbook of the Sociology of Mental Health","author":"Rosenfield","year":"2013"},{"issue":"3","key":"2019120301404114500_fdx173C38","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1016\/S0006-3223(03)00273-7","article-title":"Clinical and health services relationships between major depression, depressive symptoms, and general medical illness","volume":"54","author":"Katon","year":"2003","journal-title":"Biol Psychiatry"},{"issue":"June Suppl. 30","key":"2019120301404114500_fdx173C39","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1192\/S0007125000298474","article-title":"The relationship between pain and depression","volume":"168","author":"Von Korff","year":"1996","journal-title":"Br J Psychiatry"},{"issue":"3","key":"2019120301404114500_fdx173C40","doi-asserted-by":"crossref","first-page":"464","DOI":"10.2337\/diacare.25.3.464","article-title":"Comorbid depression is associated with increased health care use and expenditures in individuals with diabetes","volume":"25","author":"Egede","year":"2002","journal-title":"Diabetes Care"},{"issue":"5","key":"2019120301404114500_fdx173C41","doi-asserted-by":"crossref","first-page":"1511","DOI":"10.1093\/ije\/dyt127","article-title":"Mediation analysis in epidemiology: methods, interpretation and bias","volume":"42","author":"Richiardi","year":"2013","journal-title":"Int J Epidemiol"},{"issue":"6","key":"2019120301404114500_fdx173C42","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1016\/S0277-9536(96)00073-1","article-title":"Measuring the magnitude of socio-economic inequalities in health: an overview of available measures illustrated with two examples from Europe","volume":"44","author":"Mackenbach","year":"1997","journal-title":"Soc Sci Med"}],"container-title":["Journal of Public Health"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jpubhealth\/article-pdf\/40\/4\/756\/31191534\/fdx173.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jpubhealth\/article-pdf\/40\/4\/756\/31191534\/fdx173.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,12,3]],"date-time":"2019-12-03T01:41:34Z","timestamp":1575337294000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jpubhealth\/article\/40\/4\/756\/4779873"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,12,27]]},"references-count":42,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2017,12,27]]},"published-print":{"date-parts":[[2018,12,1]]}},"URL":"https:\/\/doi.org\/10.1093\/pubmed\/fdx173","relation":{},"ISSN":["1741-3842","1741-3850"],"issn-type":[{"value":"1741-3842","type":"print"},{"value":"1741-3850","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2018,12]]},"published":{"date-parts":[[2017,12,27]]}}}