Association and mediating pathways between intergenerational educational mobility and depressive symptoms: findings from high- and middle-income countries.

backgroundEducation is an important determinant of health throughout the life course. However, less is understood about whether and how intergenerational educational mobility-comparing an individual's own and their parents' education-is associated with depressive symptoms among aging populations across diverse settings. This study examines this association and its mediating pathways.

methodsUsing data from six harmonized longitudinal aging studies: the US Health and Retirement Study (HRS) and its partner studies in England, European countries, South Korea, Mexico, and China, we conducted cross-sectional (n = 94,655) and longitudinal analyses (n = 56,817) to first establish the association across diverse populations, and then strengthen causal inference by examining whether educational mobility relates to depressive symptoms over time. Educational mobility was categorized as stably low, downwardly mobile, stably middle, upwardly mobile, and stably high group based on country- and cohort-specific percentiles. Depressive symptoms were assessed using the Euro-D or CES-D. We also examined the moderating role of gender in these associations. Mediating pathways through household wealth, social activeness, and multimorbidity were also explored.

resultsLongitudinal analyses revealed consistent gradient associations across countries. Compared to the stably low group, downwardly mobile (OR: 0.84, 95% CI: 0.76-0.93), stably middle (OR: 0.78, 95% CI: 0.72-0.84), upwardly mobile (OR: 0.74, 95% CI: 0.67-0.83), and stably high (OR: 0.65, 95% CI: 0.53-0.80) showed lower odds of depressive symptoms. Gender differences emerged in European countries and South Korea, where women had lower odds than men in downwardly mobile and stably high groups. Cross-sectional results showed similar but stronger patterns. Household wealth was the most consistent mediator, explaining 24-34% of the association in the USA and comparable proportions elsewhere except for South Korea. Social activeness and multimorbidity also showed important but varying mediating proportions across countries.

conclusionsAdvantaged educational mobility is associated with reduced depressive symptoms in mid- and later-life. Household wealth, social activeness, and multimorbidity contribute as important mediators. Future policies are needed to promote intergenerational educational equity and implement integrated strategies to reduce mental health disparities.