Division of Community Health and Human Development, School of Public Health, University of California, Berkeley, CA 94720-7360, USA.
Int J Epidemiol. 2011 Dec;40(6):1565-76. doi: 10.1093/ije/dyr103. Epub 2011 Jul 7.
Depression is a major cause of disability, particularly among women; poverty heightens the risk for depression. Beyond its direct effects, maternal depression can harm children's health and development. This study aimed to assess the effects of a large-scale anti-poverty programme in Mexico (Oportunidades) on maternal depressive symptoms.
In 2003, 5050 women living in rural communities who had participated in Oportunidades since its inception were assessed and compared with a group of 1293 women from matched communities, whose families had received no exposure to Oportunidades at the time of assessment but were later enrolled. Self-reported depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CES-D). Ordinary least squares regressions were used to evaluate the treatment effect of programme participation on depression while adjusting for covariates and clustering at the community level.
Women in the treatment group had lower depressive symptoms than those in the comparison group (unadjusted mean CES-D scores: 16.9 ± 9.8 vs 18.6 ± 10.2). In multivariable analyses, programme participation was associated with lower depression whilst controlling for maternal age, education and household demographic, ethnicity and socio-economic variables [β= -1.7 points, 95% confidence interval (95% CI) -2.46 to -0.96, P < 0.001]. Reductions in perceived stress and increases in perceived control were mediators of programme effects on women.
Although Oportunidades did not target maternal mental health directly, we found modest but clinically meaningful effects on depressive symptoms. Our design permits stronger causal inference than observational studies that have linked poverty and depressive symptoms. Our results emphasize that the well-being of individuals is responsive to macro-level economic policies and programmes.
抑郁症是导致残疾的主要原因，尤其是在女性中；贫困会增加患抑郁症的风险。除了直接影响外，母亲的抑郁还会损害孩子的健康和发育。本研究旨在评估墨西哥一项大规模扶贫计划（Oportunidades）对母亲抑郁症状的影响。
2003 年，评估了 5050 名居住在农村社区、自 Oportunidades 计划启动以来一直参与该计划的妇女，并将她们与来自匹配社区的 1293 名妇女进行了比较，这些家庭在评估时没有接触过 Oportunidades，但后来被纳入其中。使用流行病学研究中心抑郁量表（CES-D）来衡量自我报告的抑郁症状。使用普通最小二乘法回归来评估计划参与对抑郁的治疗效果，同时调整协变量和社区层面的聚类。
与对照组相比，实验组的女性抑郁症状较低（未经调整的 CES-D 得分：16.9±9.8 与 18.6±10.2）。在多变量分析中，控制了母亲年龄、教育和家庭人口统计学、种族以及社会经济变量后，计划参与与抑郁程度降低相关[β=-1.7 分，95%置信区间（95%CI）-2.46 至-0.96，P<0.001]。感知压力的降低和感知控制的增加是计划对女性影响的中介因素。
尽管 Oportunidades 计划没有直接针对产妇的心理健康，但我们发现对抑郁症状有适度但具有临床意义的影响。我们的设计比将贫困和抑郁症状联系起来的观察性研究更能进行强有力的因果推断。我们的结果强调，个人的福祉对宏观经济政策和方案具有响应性。
