School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth, WA, Australia.
J Affect Disord. 2012 May;138(3):322-31. doi: 10.1016/j.jad.2012.01.021. Epub 2012 Feb 12.
Depression is more frequent in socioeconomically disadvantaged than affluent neighbourhoods, but this association may be due to confounding. This study aimed to determine the independent association between socioeconomic disadvantage and depression.
We recruited 21,417 older adults via their general practitioners (GPs) and used the Patient Health Questionnaire (PHQ-9) to assess clinically significant depression (PHQ-9≥10) and major depressive symptoms. We divided the Index of Relative Socioeconomic Disadvantage into quintiles. Other measures included age, gender, place of birth, marital status, physical activity, smoking, alcohol use, height and weight, living arrangements, early life adversity, financial strain, number of medical conditions, and education of treating GPs about depression and self-harm behaviour. After 2 years participants completed the PHQ-9 and reported their use of antidepressants and health services.
Depression affected 6% and 10% of participants in the least and the most disadvantaged quintiles. The proportion of participants with major depressive symptoms was 2% and 4%. The adjusted odds of depression and major depression were 1.4 (95% confidence interval, 95%CI=1.1-1.6) and 1.8 (95%CI=1.3-2.5) for the most disadvantaged. The adjusted odds of persistent major depression were 2.4 (95%CI=1.3-4.5) for the most disadvantaged group. There was no association between disadvantage and service use. Antidepressant use was greatest in the most disadvantaged groups.
The higher prevalence and persistence of depression amongst disadvantaged older adults cannot be easily explained by confounding. Management of depression in disadvantaged areas may need to extend beyond traditional medical and psychological approaches.
与富裕社区相比，社会经济地位较低的社区中抑郁症更为常见，但这种关联可能是由于混杂因素所致。本研究旨在确定社会经济劣势与抑郁症之间的独立关联。
我们通过全科医生招募了 21417 名老年人，并使用患者健康问卷（PHQ-9）评估了临床显著的抑郁（PHQ-9≥10）和主要抑郁症状。我们将相对社会经济劣势指数分为五分位数。其他措施包括年龄、性别、出生地、婚姻状况、身体活动、吸烟、饮酒、身高和体重、居住安排、早年逆境、经济压力、医疗条件数量以及全科医生对抑郁和自残行为的教育情况。2 年后，参与者完成了 PHQ-9，并报告了他们使用抗抑郁药和卫生服务的情况。
最不劣势和最劣势五分位数的参与者中，分别有 6%和 10%患有抑郁症。有主要抑郁症状的参与者比例分别为 2%和 4%。调整后的抑郁和重度抑郁的优势比分别为 1.4（95%置信区间，95%CI=1.1-1.6）和 1.8（95%CI=1.3-2.5），最劣势组为 1.8（95%CI=1.3-2.5）。最劣势组持续性重度抑郁的调整优势比为 2.4（95%CI=1.3-4.5）。劣势与服务利用之间没有关联。最劣势组的抗抑郁药使用率最高。
在社会经济地位较低的老年人群中，抑郁症的患病率和持续性较高，这不能简单地用混杂因素来解释。在劣势地区管理抑郁症可能需要扩展到传统的医疗和心理方法之外。
