Gutiérrez-Lobos K, Wölfl G, Scherer M, Anderer P, Schmidl-Mohl B
Department of Psychiatry, University of Vienna, Austria.
Soc Psychiatry Psychiatr Epidemiol. 2000 May;35(5):202-10. doi: 10.1007/s001270050229.
The consistently observed predominance of female over male rates in depression - in treated as well as in untreated populations - has never been satisfactorily explained. Among the many possible biological and psychosocial explanations, marital and employment status have not been extensively studied and virtually nothing is known about the combined effect of these variables on sex differences in depression. A main reason for this lack of knowledge is the limited number of cases available in epidemiological studies.
The present paper examines the combined effects of marital and employment status on sex differences in depression rates by analysing in-patient admission rates of all depressed patients aged 18-67 admitted for the first ever time to the Department of Psychiatry of the University of Vienna from a strictly defined catchment area over a period of 42 months. Stepwise Poisson regression analyses were carried out in order to identify the relative contribution of these variables to the variance of first ever in-patient admission rates for depression.
A total of 2599 depressed patients fulfilled the inclusion criteria. When analysed separately, sex, marital status and employment status were shown to have distinct influences, with the "not married" carrying a two-fold higher risk than the married (2:1), and female sex (1.7:1) as well as not being employed (1.7:1) showing similar but smaller effects. In the detailed combined analysis, marriage was significantly less advantageous for women than for men, while sex differences disappeared completely in the widowed group. Also, there was no sex difference in the employed divorced; in the employed widowed there was even a slight preponderance in men. The highest rates were found in not employed divorced women, the lowest in employed married men.
While in-patient admissions are certainly selective in relation to epidemiological data, the large sample made it possible to perform combined analyses of sex, marital status and employment status. It was shown that the statement of a female preponderance in depression, which was found for the total sample, is a gross oversimplification. If marital and employment status are considered simultaneously, the sex differences disappear in some subgroups and in some are even reversed. We suggest that the combined influence of marital and employment status should be studied in epidemiological studies as well before conclusions about the influence of sex on depression rates are drawn.
在抑郁症患者中，无论是接受治疗的还是未接受治疗的人群，始终观察到女性发病率高于男性，这一现象从未得到令人满意的解释。在众多可能的生物学和社会心理因素解释中，婚姻状况和就业状况尚未得到广泛研究，而且对于这些变量对抑郁症性别差异的综合影响几乎一无所知。造成这种知识匮乏的一个主要原因是流行病学研究中可用病例数量有限。
本文通过分析在42个月期间首次从严格定义的集水区被收治到维也纳大学精神病学系的所有18至67岁抑郁症患者的住院率，研究婚姻状况和就业状况对抑郁症发病率性别差异的综合影响。进行逐步泊松回归分析，以确定这些变量对首次抑郁症住院率方差的相对贡献。
共有2599名抑郁症患者符合纳入标准。单独分析时，性别、婚姻状况和就业状况显示出不同的影响，“未婚”者的风险是已婚者的两倍（2:1），女性（1.7:1）以及未就业者（1.7:1）的影响相似但较小。在详细的综合分析中，婚姻对女性的益处明显少于男性，而在丧偶组中性别差异完全消失。此外，就业的离婚者中没有性别差异；在就业的丧偶者中，男性甚至略有优势。未就业的离婚女性发病率最高，就业的已婚男性发病率最低。
虽然住院率与流行病学数据相比肯定具有选择性，但大样本使得对性别、婚姻状况和就业状况进行综合分析成为可能。结果表明总样本中发现的抑郁症女性占优势的说法过于简单化。如果同时考虑婚姻状况和就业状况，性别差异在一些亚组中消失，在一些亚组中甚至会逆转。我们建议在流行病学研究中也应研究婚姻状况和就业状况的综合影响，然后再得出关于性别对抑郁症发病率影响的结论。
