Research Department of Primary Care and Population Health, UCL Medical School, Rowland Hill Street, London NW3 2PF, UK.
Soc Sci Med. 2011 Dec;73(11):1627-34. doi: 10.1016/j.socscimed.2011.09.029. Epub 2011 Oct 10.
Unemployment is known to be associated with poor mental health, but it is not clear how strongly unemployment leads to onset of diagnosed clinical depression (causation), or if depression raises the risks of becoming unemployed (health selection), or indeed if both pathways operate. We therefore investigate the direction of associations between clinical depression and unemployment in a cross-cultural prospective cohort study. 10,059 consecutive general practice attendees (18-75 years) were recruited from six European countries and Chile between 2003 and 2004 and followed up at six, 12 and (in a subset) 24 months. The analysis sample was restricted to 3969 men and women who were employed or unemployed and seeking employment and had data on depression measures. The outcomes were depressive episodes, assessed using the Depression Section of the Composite International Diagnostic Interview (CIDI) and self-reported employment status. Among 3969 men and women with complete data on depression and unemployment, 10% (n = 393) had depression symptoms and a further 6% (n = 221) had major depression at 12 months. 11% (n = 423) of the sample were unemployed by 6 months. Participants who became unemployed between baseline and 6 months compared to those employed at both times had an adjusted relative risk ratio for 12-month depression of 1.58 (95% Confidence Interval 0.76, 3.27). Participants with depression at baseline and 6 months compared to neither time had an odds ratio for 6-month unemployment of 1.58 (95% Confidence Interval 0.97, 2.58). We found evidence that causation and (to a lesser extent) health selection raise the prevalence of depression in the unemployed. Unemployed adults are at particular risk for onset of major clinical depression and should be offered extra services or screened. Given the trend for adults with depression to perhaps be at greater risk of subsequent unemployment, employees with depressive symptoms should also be supported at work as a precautionary principle.
失业与心理健康不良有关，但尚不清楚失业对确诊临床抑郁症（因果关系）的影响有多大，或者是抑郁症是否会增加失业的风险（健康选择），或者实际上这两种途径是否都在起作用。因此，我们在一项跨文化前瞻性队列研究中调查了临床抑郁症与失业之间的关联方向。2003 年至 2004 年间，我们从六个欧洲国家和智利的 6 家全科诊所招募了 10059 名连续就诊者（18-75 岁），并在 6、12 和（在一个子集中）24 个月时进行了随访。分析样本仅限于 3969 名就业或失业且正在寻找工作且有抑郁测量数据的男性和女性。结果是抑郁发作，使用复合国际诊断访谈（CIDI）的抑郁部分和自我报告的就业状况进行评估。在 3969 名有完整抑郁和失业数据的男性和女性中，10%（n=393）在 12 个月时出现抑郁症状，另有 6%（n=221）患有重度抑郁症。在 6 个月时，样本中有 11%（n=423）失业。与两次均就业的参与者相比，在基线和 6 个月之间失业的参与者在 12 个月时患抑郁症的调整后相对风险比为 1.58（95%置信区间 0.76，3.27）。与两个时间都未患抑郁症的参与者相比，基线和 6 个月时患有抑郁症的参与者在 6 个月时失业的优势比为 1.58（95%置信区间 0.97，2.58）。我们有证据表明，因果关系（在较小程度上）和健康选择会增加失业者的抑郁患病率。失业的成年人尤其容易出现严重的临床抑郁症发作，应提供额外的服务或进行筛查。鉴于成年人患有抑郁症可能会增加随后失业的风险，作为预防原则，也应该在工作中支持有抑郁症状的员工。
