Galea Sandro, Ahern Jennifer, Nandi Arijit, Tracy Melissa, Beard John, Vlahov David
Department of Epidemiology, University of Michigan, School of Public Health, Ann Arbor, MI 48104, USA.
Ann Epidemiol. 2007 Mar;17(3):171-9. doi: 10.1016/j.annepidem.2006.07.008.
It has long been suggested that certain characteristics of the urban environment may influence population mental health. However, evidence from multilevel research addressing the relation between intraurban environments and depression has been conflicting, and prospective evidence in this regard has been limited. We assessed the relation between urban neighborhood poverty and incident depression in a population-based prospective cohort study.
Using random-digit-dial telephone surveys, we recruited 1570 adult residents of New York City (NYC) in 2002. All persons interviewed at baseline were contacted again for follow-up 6 and 18 months after the initial interview. Eighty-one percent of the sample completed at least one follow-up visit. Analysis was restricted to 1120 persons who could be geocoded to NYC neighborhoods, which were represented by NYC community districts (N=59).
Among persons with no history of major depression at baseline (N=820) there were 113 incident cases of major depression during the 18 months of follow-up; cumulative incidence of depression during the study period was 14.6 per hundred persons (95% confidence interval, 10.9-18.3). In low-socioeconomic status (SES) neighborhoods, the cumulative incidence of depression was 19.4 per hundred persons (95% confidence interval, 13.5-25.3), which was greater than that in high-SES neighborhoods (10.5; 95% confidence interval, 5.9-15.2). In multivariable models adjusting for individual covariates (sociodemographics, individual SES, social support, stressors, traumas, and history of post-traumatic stress disorder), the relative odds of incident depression was 2.19 (95% confidence interval, 1.04-4.59) for participants living in low-SES compared with high-SES neighborhoods.
SES of neighborhood of residence is associated with incidence of depression independent of individual SES and other individual covariates. Additional work needs to characterize the pathways that may explain the observed association between living in low-SES neighborhoods and risk for depression.
长期以来，一直有人认为城市环境的某些特征可能会影响人群的心理健康。然而，关于城市内部环境与抑郁症之间关系的多层次研究证据一直相互矛盾，而且这方面的前瞻性证据有限。我们在一项基于人群的前瞻性队列研究中评估了城市社区贫困与新发抑郁症之间的关系。
我们在2002年通过随机数字拨号电话调查招募了1570名纽约市成年居民。在初次访谈后6个月和18个月，再次联系所有在基线时接受访谈的人进行随访。81%的样本完成了至少一次随访。分析仅限于1120名可以通过地理编码确定其所在纽约市社区的人，这些社区由纽约市社区区（N = 59）代表。
在基线时无重度抑郁症病史的人群（N = 820）中，在18个月的随访期间有113例新发重度抑郁症病例；研究期间抑郁症的累积发病率为每百人14.6例（95%置信区间，10.9 - 18.3）。在社会经济地位（SES）较低的社区，抑郁症的累积发病率为每百人19.4例（95%置信区间，13.5 - 25.3），高于SES较高的社区（10.5；95%置信区间，5.9 - 15.2）。在调整了个体协变量（社会人口统计学、个体SES、社会支持、压力源、创伤和创伤后应激障碍病史）的多变量模型中，与居住在高SES社区的参与者相比，居住在低SES社区的参与者发生抑郁症的相对比值为2.19（95%置信区间，1.04 - 4.59）。
居住社区的SES与抑郁症发病率相关，独立于个体SES和其他个体协变量。需要进一步开展工作来描述可能解释居住在低SES社区与抑郁症风险之间观察到的关联的途径。
