Department of Society, Human Development and Health, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
Soc Psychiatry Psychiatr Epidemiol. 2013 Jan;48(1):59-69. doi: 10.1007/s00127-012-0575-9. Epub 2012 Sep 5.
Depression and suicide are major public health concerns, and are often unrecognized among the elderly. This study investigated social inequalities in depressive symptoms and suicidal ideation among older adults.
Data come from 1,226 participants in PROSPECT (Prevention of Suicide in Primary Care Elderly: Collaborative Trial), a large primary care-based intervention trial for late-life depression. Linear and logistic regressions were used to analyze depressive symptoms and suicidal ideation over the 2-year follow-up period.
Mean Hamilton Depression Rating Scale (HDRS) scores were significantly higher among participants in financial strain [regression coefficient (b) = 1.78, 95 % confidence interval (CI) = 0.67-2.89] and with annual incomes below $20,000 (b = 1.67, CI = 0.34-3.00). Financial strain was also associated with a higher risk of suicidal ideation (odds ratio = 2.35, CI = 1.38-3.98).
There exist marked social inequalities in depressive symptoms and suicidal ideation among older adults attending primary care practices, the setting in which depression is most commonly treated. Our results justify continued efforts to understand the mechanisms generating such inequalities and to recognize and provide effective treatments for depression among high-risk populations.
抑郁和自杀是重大的公共卫生问题，在老年人中常常未被识别。本研究调查了老年人中抑郁症状和自杀意念的社会不平等现象。
数据来自 PROSPECT（初级保健老年人预防自杀：合作试验）的 1226 名参与者，这是一项针对老年抑郁症的大型初级保健为基础的干预试验。线性和逻辑回归用于分析 2 年随访期间的抑郁症状和自杀意念。
经济拮据的参与者的汉密尔顿抑郁评定量表（HDRS）平均得分明显更高（回归系数（b）= 1.78，95%置信区间（CI）= 0.67-2.89），年收入低于 20000 美元的参与者得分也更高（b=1.67，CI=0.34-3.00）。经济拮据也与自杀意念的风险增加相关（比值比=2.35，CI=1.38-3.98）。
在接受初级保健的老年人中，抑郁症状和自杀意念存在明显的社会不平等现象，而初级保健是治疗抑郁症最常见的场所。我们的结果证明，有必要继续努力了解产生这些不平等现象的机制，并识别和为高危人群提供有效的抑郁症治疗。
