Medical Research Council/Chief Scientist Office: Social and Public Health Sciences Unit, 4 Lilybank Gardens, Glasgow, G12 8RZ, Scotland, UK,
Soc Psychiatry Psychiatr Epidemiol. 2013 Dec;48(12):1951-61. doi: 10.1007/s00127-013-0720-0. Epub 2013 Jun 4.
Socioeconomic inequalities in anxiety and depression widen with increasing age. This may be due to differences in the incidence or persistence of symptoms. This paper investigates the widening of inequalities in anxiety and depression over the lifecourse.
Data were from the West of Scotland Twenty-07 Study, constituting three cohorts aged approximately 16, 36 and 56 years at baseline and re-visited at 5-yearly intervals for 20 years. Symptoms were measured using the Hospital Anxiety and Depression Scale. Adjusting for age and sex, multilevel models with pairs of interviews (n = 6,878) nested within individuals (n = 3,165) were used for each cohort to estimate associations between current symptoms and education or household social class for both those with and without earlier symptoms, approximating socioeconomic differences in incidence and persistence.
Inequalities in current symptom levels were present for both those with and without earlier symptoms. In the youngest cohort, those with less education were more likely to experience persistent depression and to progress from anxiety to depression. At older ages there were educational and social class differences in both the persistence and incidence of symptoms, though there was more evidence of differential persistence than incidence in the middle cohort and more evidence of differential incidence than persistence in the oldest cohort.
Differential persistence and symptom progression indicate that intervening to prevent or treat symptoms earlier in life is likely to reduce socioeconomic inequalities later, but attention also needs to be given to late adulthood where differential incidence emerges more strongly than differential persistence.
焦虑和抑郁的社会经济不平等会随着年龄的增长而扩大。这可能是由于症状的发生率或持续性存在差异所致。本文研究了焦虑和抑郁在整个生命历程中不平等现象的扩大。
数据来自苏格兰西部 20-07 研究，该研究由三个队列组成，年龄分别约为 16 岁、36 岁和 56 岁，在基线时进行了测量，并在 20 年内每 5 年进行一次随访。使用医院焦虑和抑郁量表来测量症状。在调整了年龄和性别因素后，使用个体内嵌套的两次访谈（n=6878）的多层次模型（n=3165），对每个队列进行了分析，以估计当前症状与教育或家庭社会阶层之间的关联，同时考虑了那些有和没有早期症状的人群，从而近似估计了发生率和持续性方面的社会经济差异。
在那些有和没有早期症状的人群中，当前症状水平的不平等现象都存在。在最年轻的队列中，受教育程度较低的人更有可能出现持续性抑郁，并且从焦虑发展为抑郁的可能性更大。在较年长的年龄，无论是在持续性还是在症状发生率方面，都存在教育和社会阶层的差异，但在中年队列中，更多的证据表明持续性差异大于发生率差异，而在最年长的队列中，更多的证据表明发生率差异大于持续性差异。
差异持续性和症状进展表明，在生命早期干预以预防或治疗症状，可能会降低以后的社会经济不平等，但也需要关注晚年时期，因为此时的发生率差异比持续性差异更为明显。
