Lorant V, Deliège D, Eaton W, Robert A, Philippot P, Ansseau M
Health Systems Research, School of Public Health, Faculty of Medicine, Université Catholique de Louvain, Brussels, Belgium.
Am J Epidemiol. 2003 Jan 15;157(2):98-112. doi: 10.1093/aje/kwf182.
Low socioeconomic status (SES) is generally associated with high psychiatric morbidity, more disability, and poorer access to health care. Among psychiatric disorders, depression exhibits a more controversial association with SES. The authors carried out a meta-analysis to evaluate the magnitude, shape, and modifiers of such an association. The search found 51 prevalence studies, five incidence studies, and four persistence studies meeting the criteria. A random effects model was applied to the odds ratio of the lowest SES group compared with the highest, and meta-regression was used to assess the dose-response relation and the influence of covariates. Results indicated that low-SES individuals had higher odds of being depressed (odds ratio = 1.81, p < 0.001), but the odds of a new episode (odds ratio = 1.24, p = 0.004) were lower than the odds of persisting depression (odds ratio = 2.06, p < 0.001). A dose-response relation was observed for education and income. Socioeconomic inequality in depression is heterogeneous and varies according to the way psychiatric disorder is measured, to the definition and measurement of SES, and to contextual features such as region and time. Nonetheless, the authors found compelling evidence for socioeconomic inequality in depression. Strategies for tackling inequality in depression are needed, especially in relation to the course of the disorder.
社会经济地位低下通常与高精神疾病发病率、更多残疾以及获得医疗保健的机会较差相关。在精神疾病中，抑郁症与社会经济地位的关联更具争议性。作者进行了一项荟萃分析，以评估这种关联的程度、形式和影响因素。检索发现51项患病率研究、5项发病率研究和4项持续性研究符合标准。对最低社会经济地位组与最高社会经济地位组的比值比应用随机效应模型，并使用荟萃回归来评估剂量反应关系和协变量的影响。结果表明，社会经济地位低下的个体患抑郁症的几率更高（比值比 = 1.81，p < 0.001），但新发发作的几率（比值比 = 1.24，p = 0.004）低于持续性抑郁症的几率（比值比 = 2.06，p < 0.001）。观察到教育和收入存在剂量反应关系。抑郁症中的社会经济不平等是异质性的，并且根据精神疾病的测量方式、社会经济地位的定义和测量以及地区和时间等背景特征而有所不同。尽管如此，作者发现了抑郁症中社会经济不平等的有力证据。需要制定应对抑郁症不平等问题的策略，特别是与疾病病程相关的策略。
