Income, Educational Level, and Depressive Symptoms in a Time of Multiple Crises: Trends Revealed by High-Frequency Mental Health Surveillance in Germany, 2019–2024.

backgroundAn increase in depressive symptoms among adults was observed in Germany from late 2020 onward, during a time of multiple collective stressors. In view of the uneven distribution across society of vulnerability to depressive disorders, we studied the varying impact of this trend on different socioeconomic groups.

methodsUsing population-based data from the German Health Update (Gesundheit in Deutschland aktuell) study of the Robert Koch Institute (n = 95 267, data collected from April 2019 to February 2024), we calculated time series analyses for the proportion of the population screening positive for possible depressive disorder (Patient Health Questionnaire 2 summed score of 3 or above) with the aid of moving 3-month estimators and smoothing curves, stratified by socioeconomic status (educational level and income). Absolute and relative inequalities were quantified with regressionbased methods.

resultsThe proportion of the population screening positive for possible depressive disorder was higher in groups with lower educational levels and lower incomes. Particularly from 2022 onward, it rose to a much larger extent in these groups than in those with higher educational levels and higher incomes. From 2019 to 2024, the absolute inequalities, i.e., the differences between the groups with lowest and highest educational level and between the groups with lowest and highest income, rose from 10 [7;14] to 22 [8;36] and from 12 [7;17] to 30 [17;44] percentage points, respectively (means and 95% confidence intervals).

conclusionSocioeconomic inequalities in depres - sive symptoms in adults rose over the period 2019-2024. Such inequalities in mental health should be systematically monitored, and measures should be developed to improve equity with respect to health.