BRIEF REPORT Education and depressive symptoms in 22 European countries Olaf von dem Knesebeck • Elise Pattyn • Piet Bracke Received: 23 July 2010 / Revised: 24 September 2010 / Accepted: 3 October 2010 Ó Swiss School of Public Health 2010 Abstract Objectives Variations in the association between educa- tion and depressive symptoms in 22 European countries are investigated. Methods Analyses are based on the European Social Sur- vey Round 3 (N = 34,443). Education was coded according to the International Standard Classification of Education. Depressive symptoms are measured by the shortened Center for Epidemiologic Studies Depression Scale (CES-D 8). Results The results of multiple logistic regressions show that people with low education have elevated risks of experiencing a high score of depressive symptoms. Rela- tively large inequalities were observed among both sexes for Hungary and Slovenia, small and non-significant inequalities for Austria, Denmark, and Estonia. Conclusion The results indicate that educational inequal- ities in depressive symptoms are a generalized although not invariant phenomenon. Keywords Educational inequalities Á Depressive symptoms Á Europe Á International differences Introduction The positive association between education and health is well established. People with higher education generally experience lower morbidity and mortality rates than the poorly educated (Ross and Wu 1995; Cavelaars et al. 1998; Silventoinen and Lahelma 2002; Huisman et al. 2005; Knesebeck et al. 2006). Similar gradients have been found for mental disorders (Dohrenwend et al. 1992). The results of a meta-analysis published in 2003 (Lorant et al. 2003) indicate that individuals with a low socioeconomic position (including education) have significantly higher prevalences of depression. Furthermore, a longitudinal study showed that worsening socioeconomic circumstances are associ- ated with increases in depressive symptoms (Lorant et al. 2007). Despite the progress in research on inequalities in depression according to education, there is not much known about the way in which the association between education and depression varies among countries. Com- parison of varied types of societies can provide new insights into the sensitivity of social inequalities within different societal and cultural contexts (Cavelaars et al. 1998; Silventoinen and Lahelma 2002; Huisman et al. 2003; Knesebeck et al. 2006; Mackenbach et al. 2008). They also enable us to evaluate the generalizability of findings from one national setting only. There is a lack of international comparative studies dealing with the country differences in inequalities in depression. Against this background, this study investigates educational inequalities in depressive symptoms in 22 European countries. Methods Data in this study are delivered by the European Social Survey Round 3 (http://ess.nsd.uib.no/). Data were gath- ered in 22 countries (Austria, Belgium, Bulgaria, Switzerland, Germany, Denmark, Estonia, Spain, Finland, France, United Kingdom, Hungary, Ireland; Netherlands, O. von dem Knesebeck (&) Department of Medical Sociology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany e-mail: o.knesebeck@uke.uni-hamburg.de E. Pattyn Á P. Bracke Department of Sociology, Ghent University, Ghent, Belgium Int J Public Health DOI 10.1007/s00038-010-0202-z