Axinn William G, Ghimire Dirgha J, Williams Nathalie E, Scott Kate M
Survey Research Center, College of Literature, Science, and the Arts, Institute for Social Research, University of Michigan, PO Box 1248, Ann Arbor, MI, 48106-1248, USA.
Survey Research Center, Population Studies Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.
Soc Psychiatry Psychiatr Epidemiol. 2015 Oct;50(10):1537-45. doi: 10.1007/s00127-015-1042-1. Epub 2015 Mar 22.
We provide rare evidence of factors producing psychiatric variation in a general population sample from rural South Asia. The setting is particularly useful for demonstrating that variations in the social organization of communities, often difficult to observe in rich countries, are associated with important variations in mental health.
Clinically validated survey measures are used to document variation in psychiatric disorders among 401 adults. This sample is chosen from a systematic sample of the general population of rural Nepal, in a community-level-controlled comparison design. Multilevel logistic regression is used to estimate multivariate models of the association between community-level nonfamily social organization and individual-level psychiatric disorders.
Schools, markets, health services and social support groups each substantially reduce the odds of depression, post-traumatic stress disorder (PTSD), intermittent explosive disorder and anxiety disorders. Associations between schools, health services and social support groups and depression are statistically significant and independent of each other. The association between access to markets and PTSD is statistically significant and independent of other social organization and support groups.
Community integration of some nonfamily social organizations promotes mental health in ways that may go unobserved in settings with many such organizations. More research on the mechanisms producing these associations is likely to reveal potential avenues for public policy and programs to improve mental health in the general population.
我们提供了来自南亚农村普通人群样本中产生精神疾病差异因素的罕见证据。该研究背景对于证明社区社会组织的差异（在富裕国家往往难以观察到）与心理健康的重要差异相关特别有用。
使用经过临床验证的调查方法记录401名成年人中精神疾病的差异。该样本选自尼泊尔农村普通人群的系统样本，采用社区层面控制的比较设计。使用多水平逻辑回归来估计社区层面非家庭社会组织与个体层面精神疾病之间关联的多变量模型。
学校、市场、卫生服务和社会支持团体均大幅降低了患抑郁症、创伤后应激障碍（PTSD）间歇性爆发障碍和焦虑症的几率。学校、卫生服务和社会支持团体与抑郁症之间的关联具有统计学意义且相互独立。获得市场资源与创伤后应激障碍之间的关联具有统计学意义，且独立于其他社会组织和支持团体。
一些非家庭社会组织的社区融合以在有许多此类组织的环境中可能未被观察到的方式促进心理健康。对产生这些关联的机制进行更多研究可能会揭示公共政策和项目改善普通人群心理健康的潜在途径。
