Zou Huijing, Chen Yuxia, Fang Wenjie, Zhang Yanting, Fan Xiuzhen
School of Nursing, Shandong University, Jinan, Shandong Province, PR China.
School of Nursing, Shandong University, Jinan, Shandong Province, PR China.
J Psychosom Res. 2016 Dec;91:33-39. doi: 10.1016/j.jpsychores.2016.10.006. Epub 2016 Oct 19.
Depressive symptoms are prevalent and cause adverse outcomes in heart failure. Previous studies have linked depressive symptoms with socioeconomic status. However, little is known about the mechanisms underlying this relationship. This study aimed to evaluate the association between socioeconomic status and depressive symptoms, and to examine whether access to healthcare, health literacy and social support mediated this relationship in patients with heart failure.
Cross-sectional design was used to study 321 patients with heart failure recruited from a general hospital. Demographics, clinical data, depressive symptoms, socioeconomic status (i.e., education, employment, income, and subjective social status), access to healthcare, health literacy, and social support were collected by patient interview, medical record review or questionnaires. A series of logistic regressions and linear regressions were conducted to examine mediation.
The mean age of patients with heart failure was 63.6±10.6years. Fifty-eight patients (18%) had depressive symptoms. Lower subjective social status (OR=1.321, p=0.012) and lower health literacy (OR=1.065, p<0.001) were separately associated with depressive symptoms. When subjective social status and health literacy were entered simultaneously, the relationship between subjective social status and depressive symptoms became non-significant (OR=1.208, p=0.113), demonstrating mediation. Additionally, lower social support was associated with depressive symptoms (OR=1.062, p=0.007).
In patients with heart failure, health literacy mediated the relationship between subjective social status and depressive symptoms. Lower social support was associated with depressive symptoms. Interventions should take these factors into account.
抑郁症状在心力衰竭患者中普遍存在，并会导致不良后果。既往研究已将抑郁症状与社会经济地位联系起来。然而，对于这种关系背后的机制知之甚少。本研究旨在评估社会经济地位与抑郁症状之间的关联，并探讨获得医疗保健服务、健康素养和社会支持是否介导了心力衰竭患者中的这种关系。
采用横断面设计研究从一家综合医院招募的321例心力衰竭患者。通过患者访谈、病历审查或问卷调查收集人口统计学资料、临床数据、抑郁症状、社会经济地位（即教育程度、就业情况、收入和主观社会地位）、获得医疗保健服务的情况、健康素养和社会支持。进行一系列逻辑回归和线性回归以检验中介作用。
心力衰竭患者的平均年龄为63.6±10.6岁。58例患者（18%）有抑郁症状。较低的主观社会地位（OR=1.321，p=0.012）和较低的健康素养（OR=1.065，p<0.001）分别与抑郁症状相关。当同时纳入主观社会地位和健康素养时，主观社会地位与抑郁症状之间的关系变得不显著（OR=1.208，p=0.113），表明存在中介作用。此外，较低的社会支持与抑郁症状相关（OR=1.062，p=0.007）。
在心力衰竭患者中，健康素养介导了主观社会地位与抑郁症状之间的关系。较低的社会支持与抑郁症状相关。干预措施应考虑这些因素。
