Thurston Rebecca C, Kubzansky Laura D, Kawachi Ichiro, Berkman Lisa F
Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, MA, USA.
Psychosom Med. 2006 Jan-Feb;68(1):25-32. doi: 10.1097/01.psy.0000195883.68888.68.
Depression and anxiety are frequently hypothesized yet rarely examined pathways linking low socioeconomic status (SES) to coronary heart disease (CHD). This study evaluates depression and anxiety as mediators of the association between educational attainment and incident CHD.
Subjects (n = 6265, age 25-74) were participants in NHANES I and follow-up studies, a longitudinal, nationally representative study of the US population. Measures of educational attainment and depressive and anxious symptoms (General Well-Being Schedule) were derived from the baseline interview and incident CHD from hospital records and death certificates. Analyses included logistic regression and Cox proportional hazards models.
In fully adjusted models, less than high school (relative risk [RR] = 1.46; 95% confidence interval [CI], 1.15-1.86) and some college (RR = 1.40; 95% CI, 1.05-1.88) education were associated with increased CHD risk relative to a college education. High depressive (RR = 1.31; 95% CI, 1.06-1.61) or anxious (RR = 1.35; 95% CI, 1.13-1.62) symptoms were associated with significantly increased CHD risk relative to low symptoms. Low educational levels were associated with increased risk for high depressive (OR = 3.43; 95% CI, 2.34-5.03) and anxious (OR = 1.71; 95% CI, 1.32-2.22) symptoms. However, depressive and anxious symptoms accounted for little of the association between education and CHD.
Education and depressive and anxious symptoms are associated with each other and risk of incident CHD. Although depressive and anxious symptoms are highest among those with lowest levels of education, they do not appear to mediate the relation between educational attainment and incident CHD. Findings suggest the importance of interventions to reduce socioeconomic disadvantage and negative affect in preventing CHD.
抑郁和焦虑常被认为是社会经济地位低下（SES）与冠心病（CHD）之间的联系途径，但很少得到研究。本研究评估抑郁和焦虑作为教育程度与冠心病发病之间关联的中介因素。
研究对象（n = 6265，年龄25 - 74岁）参与了美国国家健康和营养检查调查（NHANES I）及其随访研究，这是一项针对美国人群的具有全国代表性的纵向研究。教育程度以及抑郁和焦虑症状（总体幸福感量表）的测量数据来自基线访谈，冠心病发病情况则来自医院记录和死亡证明。分析方法包括逻辑回归和Cox比例风险模型。
在完全调整模型中，与大学教育相比，高中以下学历（相对风险[RR] = 1.46；95%置信区间[CI]，1.15 - 1.86）和部分大学学历（RR = 1.40；95% CI，1.05 - 1.88）与冠心病风险增加相关。与低症状水平相比，高抑郁（RR = 1.31；95% CI，1.06 - 1.61）或高焦虑（RR = 1.35；95% CI，1.13 - 1.62）症状与冠心病风险显著增加相关。低教育水平与高抑郁（优势比[OR] = 3.43；95% CI，2.34 - 5.03）和高焦虑（OR = 1.71；95% CI，1.32 - 2.22）症状风险增加相关。然而，抑郁和焦虑症状在教育与冠心病之间的关联中所占比例很小。
教育以及抑郁和焦虑症状相互关联，且与冠心病发病风险相关。尽管抑郁和焦虑症状在教育程度最低的人群中最为严重，但它们似乎并未介导教育程度与冠心病发病之间的关系。研究结果表明，在预防冠心病方面，采取干预措施减少社会经济劣势和负面影响具有重要意义。
