Fone David, Dunstan Frank, Williams Gareth, Lloyd Keith, Palmer Stephen
Department of Epidemiology, Statistics & Public Health, Centre for Health Sciences Research, Cardiff University, UK.
Soc Sci Med. 2007 Feb;64(3):633-45. doi: 10.1016/j.socscimed.2006.09.020. Epub 2006 Oct 27.
This paper investigates multilevel associations between the common mental disorders of anxiety, depression and economic inactivity measured at the level of the individual and the UK 2001 census ward. The data set comes from the Caerphilly Health & Social Needs study, in which a representative survey of adults aged 18-74 years was carried out to collect a wide range of information which included mental health status (using the Mental Health Inventory (MHI-5) scale of the Short Form-36 health status questionnaire), and socio-economic status (including employment status, social class, household income, housing tenure and property value). Ward level economic inactivity was measured using non-means tested benefits data from the Department of Work and Pensions (DWP) on long-term Incapacity Benefit and Severe Disablement Allowance. Estimates from multilevel linear regression models of 10,653 individuals nested within 36 census wards showed that individual mental health status was significantly associated with ward-level economic inactivity, after adjusting for individual-level variables, with a moderate effect size of -0.668 (standard error=0.258). There was a significant cross-level interaction between ward-level and individual economic inactivity from permanent sickness or disability, such that the effect of permanent sickness or disability on mental health was significantly greater for people living in wards with high levels of economic inactivity. This supports the hypothesis that living in a deprived neighbourhood has the most negative health effects on poorer individuals and is further evidence for a substantive effect of the place where you live on mental health.
本文研究了焦虑、抑郁等常见精神障碍与个体层面及英国2001年人口普查区层面的经济不活跃之间的多层次关联。数据集来自卡菲利健康与社会需求研究，该研究对18 - 74岁的成年人进行了代表性调查，以收集广泛的信息，包括心理健康状况（使用简短型36项健康状况问卷中的心理健康量表（MHI - 5））和社会经济状况（包括就业状况、社会阶层、家庭收入、住房保有形式和房产价值）。普查区层面的经济不活跃程度是根据工作和养老金部（DWP）关于长期丧失工作能力福利和严重残疾津贴的非经济状况调查福利数据来衡量的。对嵌套在36个普查区内的10,653名个体进行的多层次线性回归模型估计表明，在调整个体层面变量后，个体心理健康状况与普查区层面的经济不活跃显著相关，效应大小适中，为 - 0.668（标准误差 = 0.258）。因长期疾病或残疾导致的普查区层面和个体层面的经济不活跃之间存在显著的跨层次交互作用，即对于生活在经济不活跃程度高的普查区的人来说，长期疾病或残疾对心理健康的影响显著更大。这支持了以下假设：生活在贫困社区对较贫困个体的健康产生最负面的影响，并且进一步证明了你居住的地方对心理健康有实质性影响。
