Abstract
<title>Abstract</title> <p> <bold>Background:</bold> Educational attainment is considered a social protective factor against depression risk, but less in known about sex-specific associations between education and the odds, progression, and severity of depressive symptoms in older populations. This study investigated these associations among middle-aged and older adults in Northern Sweden. <bold>Methods:</bold> We used data from the Betula longitudinal cohort study in Umeå, Sweden. Depressive symptoms were measured using the CES-D scale across multiple waves (1998-2014). We used mixed-effects logistic, linear and ordinal regression models. Marginal population means and exceedance probabilities were estimated. <bold>Results:</bold> The study included 1013 individuals (men=503, women=510). Higher education, particularly secondary education, was associated with higher odds of depression (Odds ratio [OR] for secondary vs primary = 1.88, 95% CI 1.08–3.30). Sex-stratified analyses indicated positive associations (i.e., all ORs > 1, although not statistically significant), with a pronounced association in women with secondary education. Among women neither the linear mixed model nor the ordinal regression model showed any statistical evidence of educational differences in depression progression or severity. In men, the linear mixed model suggested decreasing symptom severity among higher-educated men and increasing severity among those with primary education over time ( <italic>P</italic> for interaction < 0.05). Similar patterns appeared in the ordinal model. <bold>Conclusions:</bold> Our study suggests higher education is associated with higher the odds of depression particularly in women. Evidence for educational differences in symptom progression was only evident among men. These findings highlight a complex relationship between education and depression in Swedish older adults, underscoring the need for validation in larger studies. </p>