아동기 사회경제적 위기요인과 노년기 우울: 잠재계층분석을 활용하여 = Childhood Socioeconomic Risk Factors and Depression in Old Age: A Latent Class Analysis

다국어 초록 (Multilingual Abstract)

Guided by a life-course perspective, this study investigated the associations between childhood socioeconomic risk factors and depression in old age by identifying subgroups among older adults according to socioeconomic risk factors in childhood. This study used the nationally longitudinal survey data (2006 to 2010) from the Korea Welfare Panel Study (KOWEPS). The sample included 3,779 older adults aged 65 or over. A latent class analysis, one of the person-centered approaches,was adopted to identify latent classes according to childhood socioeconomic risk factors. Then, a multiple regression model was used to analyze the association between the latent classes and depression in old age. This study found three groups of latent classes, which were named as the multiple risk group, the low SES group, and the low risk group. The latent classes by childhood socioeconomic risk factors were associated with current SES variables and depression in old age.
Furthermore, the differences between the multiple risk group and the other two groups were still significant with current SES variables controlled. Our findings suggest that childhood socioeconomic risk factors maintain a connection with and have a predictive role in the depression of older adults.
The practical implications of these findings were discussed. The strong association between childhood socioeconomic risk factors and depression in old age highlights the importance of early life circumstances on elderly health. Early stage recognition, prevention and supportive measures against childhood socioeconomic disadvantages should be promoted in order to prevent elderly depression and further diminish socioeconomic inequality in health in old age.

국문 초록 (Abstract)

본 연구에서는 다섯 가지 아동기 사회경제적 위기요인에 따라 구분되는 하위집단(잠재계층)의 수와 그 형태를 알아보고, 잠재계층과 현재의 사회경제적 지위 변인 사이의 관계를 분석하였다. 나아가 생애과정 관점에 기초하여 아동기 사회경제적 위기요인에 따른 잠재계층과 노년기 우울 사이의 관계를 살펴보고, 현재의 사회경제적 지위 변인을 통제한 후 아동기 사회경제적 위기요인에 따른 잠재계층이 노년기 우울에 미치는 독립적 영향을 검증하였다. 본 연구는 한국복지패널 1차 조사에서 5차 조사까지에 해당하는 2006년부터 2010년까지의자료에서 만 65세 이상의 남녀를 대상으로 하였다. 자료의 분석을 위해 인간 중심적 접근법(person-centered approaches)의 하나인 잠재계층분석(latent class analysis)을 적용하여 아동기 사회경제적 위기요인에 따라 구분되는 잠재계층을 추출하고, 중다회귀분석방법을 이용하여 잠재계층과 노년기 우울과의 관련성을 분석하였다. 분석 결과 세 개의 잠재계층이 도출되었고, 그 형태에 따라 다중위기 집단, 낮은 사회적 지위 집단, 저위기집단으로 명명하였다. 아동기에 어떤 잠재계층에 속하느냐는 현재의 사회경제적 지위 변인 및 노년기 우울과관계가 있는 것으로 나타났다. 특히 다중위기 집단과 다른 두 집단들 간의 노년기 우울에 있어서의 차이는 현재의 사회경제적 지위 변인을 통제한 후에도 유의하게 남아 있었다. 아동기 사회경제적 위기요인이 노년기 우울에 미치는 영향에 관한 이 연구는 건강한 노후를 위한 장기적이고 전생애적인 정책적 개입의 필요성을 부각시킴으로써 노년기 정신건강 증진을 위한 새로운 방안을 모색하는 데 기여할 것으로 기대된다.

참고문헌 (Reference)

1 강영호, "한국의 건강불평등 현황" 2006

2 권재기, "집단따돌림 피해경험의 발달양상과 내면화⋅외현화 문제행동의 변화 －잠재계층 성장분석(LCGA)⋅다집단 성장혼합모형(GMM)을 이용한 종단연구－" 한국아동복지학회 34 (34): 95-126, 2011

3 서제희, "아동기 및 성인기 사회경제적 위치와 세대 간 사회 이동이 성인기 건강에 미치는 영향" 대한예방의학회 43 (43): 138-150, 2010

4 강영걸, "사회복지조사론" 현학사 2004

5 강영호, "사회경제적 건강 불평등에 대한 생애적 접근법" 대한예방의학회 38 (38): 267-275, 2005

6 전혜정, "노인자살위험평가" 2010

7 김현순, "노인의 자살생각에 대한 경로분석" 한국상담심리학회 19 (19): 801-818, 2007

8 유정헌, "노년기 우울에 대한 가족관계 만족도의 중재효과" 한국노년학회 29 (29): 717-728, 2009

9 전해숙, "노년기 우울궤적의 예측요인: 한국복지패널을 이용하여" 한국노년학회 29 (29): 1611-1628, 2009

10 홍세희, "구조방정식 모델: 초급, 중급" S&M리서치그룹 2008

11 Gilman, S. E., "socioeconomic status in childhood and the lifetime risk of major depression" 31 : 359-367, 2002

12 Lynch, J. W., "Why do poor people behave poorly? variation in adult health behaviors and psychological characteristics by stages of the socioeconomic life course" 44 (44): 809-819, 1997

13 Zajacova, A., "Unobserved heterogeneity can confound the effect of education on mortality" 16 : 153-173, 2009

14 Huang, J., "Trajectory of depression symptoms and related factors in later life : A population based study" 133 : 499-508, 2011

15 Iwamoto, D. K., "Trajectory classes of heavy episodic drinking among Asian American college students" 105 : 1912-1920, 2010

16 Haas, S., "Trajectories of functional health : the 'long arm' of childhood health and socioeconomic factors" 66 : 849-861, 2008

17 Pearlin, L. I., "The stress process" 22 : 237-256, 1981

18 Palloni, A., "The influence of early conditions on health status among elderly puerto ricans" 52 (52): 132-163, 2005

19 Kwag, K. H., "The cumulative influences of socioeconomic status on healthoutcomes in late adulthood: A latent growth curve analysis" HumanDevelopment and Family Studies, Iowa State University 2009

20 Ferraro, K. F., "The color of hospitalization over the adult life course: cumulative disadvantage in Black and White?" 61B (61B): S299-S306, 2006

21 Hwang, J., "The Val66Met polymorphism of the brain-derived neurotrophic-factor gene is associated with geriatric depression" 27 : 1834-1837, 2006

22 Case, A., "The Lasting Impact of Childhood Health and Circumstance" 24 (24): 365-389, 2005

23 Luo, Y., "The Impact of Childhood and Adult SES on Physical, Mental, and Cognitive Well-Being in Later Life" 60B (60B): 93-101, 2005

24 Radloff, L. S., "The CES-D scale A self-report depression scale for research in the general population" 1 (1): 385-401, 1977

25 Galobardes, B., "Systematic review of the influence of childhood socioeconomic circumstances onriskfor cardiovascular disease in adulthood" 16 (16): 91-104, 2006

26 Heisel, M. J., "Suicide prevention in older adults" 12 (12): 242-259, 2006

27 Turner, R. J., "Status variations in stress exposure : Implications for the interpretation of research on race, socioeconomic status, and gender" 44 (44): 488-505, 2003

28 Little, R. J. A., "Statistical Analysis with Missing Data" John Wiley 2002

29 Schöllgen, I., "Socioeconomic status and health in the second half of life, findings from the German Ageing Survey" 7 : 7-18, 2010

30 Grzywacz, J. G., "Socioeconomic status and health : A micro-level analysis of exposure and vulnerability to daily stressors" 45 : 1-16, 2004

31 Kim, J., "Socioeconomic status and age trajectories of health" 65 : 2489-2502, 2007

32 Muntaner, C., "Socioeconomic position and major mental disorders" 26 (26): 53-62, 2004

33 Herd, P., "Socioeconomic position and health : The differential effects of educationversus income on the onset versus progression of health problems" 48 : 223-238, 2007

34 Turrell, G., "Socioeconomic position across the lifecourse and cognitive function in late middle age" 57B (57B): 347-362, 2002

35 Gilman S. E., "Socio-economic status, family disruption and residential stability in childhood : relation to onset, recurrence and remission of major depression" 33 (33): 1341-1355, 2003

36 Aneshensel, C. S., "Social stress : Theory and research" 18 : 15-38, 1992

37 George, L. K., "Social factors, depression, and aging, In Handbook of Aging and Social Science (chapter 11)" Online ebook 149-161, 2011

38 Palloni, A., "Reproducing inequalities : Luck, wallets, and the enduring effects of childhood health" 43 (43): 587-615, 2006

39 Khang, Y. H., "Relationship between childhood socioeconomic position and mortality risk in adult males of the Korea Labour and Income Panel Study(KLIPS)" 120 : 724-731, 2006

40 de Leon, C. F. M., "Racial disparities in disability: recent evidence from self-reported and performance-based disability measures in a population-based study of older adults" 60B (60B): 263-271, 2005

41 Reynolds, C. F., "Preventing depression in old age : It’s time" 16 (16): 433-434, 2008

42 Magnusson, D., "Person-context interaction theories, In Handbookof childpsychology: Vol. 1. Theoretical models of human development" Wiley 685-759, 1998

43 Sumanen, M. P., "Peptic ulcer and childhood adversities experienced by working-aged people" 15 (15): 3405-3410, 2009

44 Siegel, M., "On the life course perspective in income related health inequalities, a semiparametric approach" University of Cologne 2010

45 Muthen, L. K., "Mplus user's guide" Muthen & Muthen 1998

46 Lanza, S. T., "Modeling the interplay of multilevel risk factors for future academic andbehavior problems : A person-centered appeoach" 22 (22): 313-335, 2010

47 Pratt, C. C., "Measuring Program outcomes : Using retrospective pretestmethodology" 21 : 341-349, 2000

48 Beekman, A. T., "Major and minor depression in later life : a study of prevalence and risk factors" 36 (36): 65-75, 1995

49 Smith, G. D., "Lifetime socioeconomic position and mortality : prospective observational study" 314 (314): 547-552, 1997

50 Harper, S., "Life course socioeconomic conditions and adult psychosocial functioning" 31 : 395-403, 2002

51 Muthen, B. O., "Latent variable analysis: Growth mixture modeling and related techniques for longitudinal data, In Handbook of Quantitative Methodology for the Social Sciences" SAGE 345-368, 2004

52 Parra, G. R., "Investigation of profiles of risk factors for adolescent psychopathology : A person-centered approach" 35 (35): 386-402, 2006

53 Lanza, S. T., "Identification and prediction of latent classes of weight-loss strategies among women" 18 (18): 833-840, 2009

54 Kraemer, H. C., "How do risk factors work together? Mediators, moderators, andindependent, overlapping, and proxy risk factors" 158 : 848-856, 2001

55 Cockerham, W. C., "Health lifestyle theory and the convergence of agency and structure" 46 : 51-67, 2005

56 Braveman, P., "Health disparities beginning in childhood : a life-course perspective" 124 (124): 163-175, 2009

57 Nagin, D. S., "Group-basedmodeling of development" Harvard University Press 2005

58 McLachlan, G., "Finitemixture models" Wiley 2000

59 Phelan, J. C., "Fear of people with mental illnesses : the role of personal and impersonal contact and exposure to threat or harm" 45 (45): 68-80, 2004

60 Lam, L. L., "Factors underlying variable DNA methylation in a human community cohort" 109 (109): 2012

61 Khang, Y. H., "Explainingsocioeconomic inequality in mortality among South Koreans : an examination of multiple pathways in a nationally representative longitudinal study" 34 (34): 630-637, 2005

62 Schwarz, G., "Estimatingthedimensionof amodel" 6 (6): 461-464, 1978

63 Essex, M. J., "Epigenetic Vestiges of Early Developmental Adversity : Childhood Stress Exposure and DNA Methylation in Adolescence" 84 (84): 58-75, 2013

64 Blazer, D. G., "Epidemiology of Psychiatric Illness, In The Medical Basis of Psychiatry" 547-559, 2008

65 Elo, I. T., "Effects of Early Life Conditions on AdultMortality : A Review" 58 (58): 186-212, 1992

66 Dupre, M., "Educational differences in age-related patterns of disease : reconsidering the cumulative disadvantage and age-as-leveler hypotheses" 48 (48): 1-15, 2007

67 Mirowsky, J., "Education, social status, andhealth" Aldine de Gruyter 2003

68 Mirowsky, J., "Education and self-rated health, cumulative advantage and its rising importance" 30 : 93-122, 2008

69 Zhang, Z., "Early life influences on cognitive impairment among oldest old chinese" 63B (63B): S25-S33, 2008

70 Luyckx, K., "Developmental typologies of identity formation and adjustment in female emerging Adults : A Latent Class Growth Analysis Approach" 18 (18): 595-519, 2008

71 Fiske, A., "Depression in older adults" 5 : 363-389, 2009

72 Nylund, K. L., "Deciding on the number of classes in latent class analysis and growth mixture modeling : A Monte Carlo simulation study" 14 (14): 535-569, 2007

73 Ferraro, K. F., "Cumulative disadvantage and health : long-termconsequences of obesity?" 68 (68): 707-729, 2003

74 Dannefer, D., "Cumulative advantage, disadvantage and the life course: cross-fertilizing age and social science theory" 58B (58B): 327-337, 2003

75 O'Rand, A. M., "Cumulative advantage theory in life course research, In Annual review of gerontology and geriatrics, focus on economic outcomes in later life" Springer 14-30, 2003

76 Phelan, J. C., "Controllingdisease and creating disparities: A fundamental cause perspective" 60B (60B): 27-33, 2005

77 Hatch, S. L., "Conceptualizing and identifying cumulative adversity and protective resources: implications for understanding health inequalities" 60B : 130-134, 2005

78 Birnie, K., "Childhood socioeconomic position and objectively measured physical capability levels in adulthood: a systematic review and meta-analysis" 6 (6): e15564-, 2011

79 Galobardes, B., "Childhood socioeconomic circumstances and causespecific mortality in adulthood : systematic review and interpretation" 26 (26): 7-21, 2004

80 Schafer, M. H., "Childhood misfurtune as a threat to successful aging_avoiding disease" 52 (52): 111-120, 2012

81 Graham, H., "Childhood disadvantage andhealthinequalities : a frameworkfor policy based on lifecourse research. ChildCare" 30 (30): 671-678, 2004

82 Preston, S. H., "Childhood conditions that predict survival to advanced ages among African-Americans" 47 (47): 1231-1246, 1998

83 Lynch, J. W., "Childhood and adult socioeconomic status as predictors of mortality in Finland" 343 : 524-527, 1994

84 Wilson, R. S., "Childhood adversity and psychosocial adjustment in old age" 14 (14): 307-315, 2006

85 Lawlor, D. A., "Association of childhood socioeconomic position with cause-specific mortality in a prospective record linkage study of 1, 839, 384 individuals" 164 (164): 907-915, 2006

86 Jung, T., "An introduction to latent class growth analysis and growth mixture modeling" 2 : 302-317, 2008

87 Smits, F., "An epidemiological approach to depression prevention in old age" 16 (16): 444-453, 2008

88 Kuh, D., "Alife course approach to chronic disease epidemiology" Oxford University Press 2004

89 Ferraro, K. F., "Aging and cumulative inequality: howdoes inequality get under the skin?" 49 (49): 333-343, 2009

90 Danese, A., "Adverse childhood experiences and adult risk factors for age-relateddisease" 163 (163): 1135-1143, 2009

91 Enders, C. K., "A primer on maximum likelihood algorithms foruse with missing data" 8 (8): 128-141, 2001

92 Prus, S. G., "A life course perspective on the relationship between socio- economic status and health: Testing the divergence hypothesis" 23 : 145-153, 2004

93 Kuh, D., "A life course approach to healthy aging, frailty, and capability" 62A (62A): 717-721, 2007