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Cited by 74Mental Health Treatment and AccessHealth disparities and outcomesSuicide and Self-Harm Studies

Social determinants of depression and suicidal behaviour in the Caribbean: a systematic review

Open access
The U.S. Caribbean Alliance for Health Disparities Research Group (USCAHDR), Brown, Catherine R, Hambleton, Ian R, Sobers-Grannum, Natasha, Hercules, Shawn M, Unwin, Nigel, Nigel Harris, E, Wilks, Rainford +3 more·2017·BMC Public Health
DOI 10.1186/s12889-017-4371-zPMC PMC5472962
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Abstract

BACKGROUND: Depressive disorder is the largest contributor to years lived with disability in the Caribbean, adding 948 per 100,000 in 2013. Depression is also a major risk factor for suicidal behaviour. Social inequalities influence the occurrence of depression, yet little is known about the social inequalities of this condition in the Caribbean. In support of the 2011 Rio Political Declaration on addressing health inequities, this article presents a systematic review of the role of social determinants on depression and its suicidal behaviours in the Caribbean. METHODS: Eight databases were searched for observational studies reporting associations between social determinants and depression frequency, severity, or outcomes. Based on the PROGRESS-plus checklist, we considered 9 social determinant groups (of 15 endpoints) for 6 depression endpoints, totalling 90 possible ways ('relationship groups') to explore the role of social determinants on depression. Studies with ≥50 participants conducted in Caribbean territories between 2004 and 2014 were eligible. The review was conducted according to STROBE and PRISMA guidelines. Results were planned as a narrative synthesis, with meta-analysis if possible. RESULTS: From 3951 citations, 55 articles from 45 studies were included. Most were classified as serious risk of bias. Fifty-seven relationship groups were reported by the 55 included articles, leaving 33 relationship groups (37%) without an evidence base. Most associations were reported for gender, age, residence, marital status, and education. Depression, its severity, and its outcomes were more common among females (except suicide which was more common among males), early and middle adolescents (among youth), and those with lower levels of education. Marriage emerged as both a risk and protective factor for depression score and prevalence, while several inequality relationships in Haiti were in contrast to typical trends. CONCLUSION: The risk of bias and few numbers of studies within relationship groups restricted the synthesis of Caribbean evidence on social inequalities of depression. Along with more research focusing on regional social inequalities, attempts at standardizing reporting guidelines for observational studies of inequality and studies examining depression is necessitated. This review offers as a benchmark to prioritize future research into the social determinants of depression frequency and outcomes in the Caribbean.

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  • Having only primary education was associated with a higher risk of depression compared to having secondary or higher education.

    “A study within a systematic review indicated that having only primary education was associated with a higher risk of depression compared to having secondary or higher education (although another study contrasted this finding) [296].”

    From Biological, Psychological, and Social Determinants of Depression: A Review of Recent Literature (2021) · cites this paper as [296]

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  1. [26]Elsevier R&D Solutions. Embase Fact Sheet. 2015. https://www.elsevier.com/__data/assets/pdf_file/0016/59011/R_D_Solutions_Embase_Fact_Sheet-Web.pdf. Accessed 13 Aug 2015.
  2. [27]SciELO FAPESP, BIRME. SciELO. SciELO. n.d.; http://www.scielo.br/. Accessed 13 Aug 2015

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Authors
The U.S. Caribbean Alliance for Health Disparities Research Group (USCAHDR), Brown, C. R., Hambleton, I. R., Sobers-Grannum, N., Hercules, S. M., Unwin, N., Nigel Harris, E., Wilks, R., MacLeish, M., Sullivan, L., & Murphy, M. M.
Affiliations
  • McMaster University (CA)
  • University of the West Indies (JM)
  • University of the West Indies (BB)
Corresponding author
Brown, Catherine R
ORCID
Venue
BMC Public Health
Publisher
Springer Science and Business Media LLC
Published
2017-06-15
Volume
17
Issue
1
Pages
577-577
ISSN
1471-2458 (ISSN-L)
DOI
10.1186/s12889-017-4371-z
PMC
PMC5472962
OpenAlex
W2624709243
Cited by
74
References
94
Citations by year
2026: 3 · 2025: 9 · 2024: 6 · 2023: 10 · 2022: 11 · 2021: 13 · 2020: 6 · 2019: 12 · 2018: 4
FWCI
0.93
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Public Health (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Apollo (University of Cambridge) (submittedVersion, cc-by)
  • Apollo (cc-by)
Funders
National Institute on Minority Health and Health Disparities (U24MD006959)
Topics
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Health › Health disparities and outcomes
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
Keywords
depression, suicidal behavior, social determinants of health, social inequality, Caribbean, health disparities, gender differences, age differences, marital status, educational attainment, depression severity, suicide, Haiti
MeSH terms
Depressive Disorder, Humans, Risk Factors, Severity of Illness Index, Suicide, Prevalence, Age Distribution, Sex Distribution, Caribbean Region, Observational Studies as Topic, Social Determinants of Health

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