经济衰退期间与心理健康相关的社会经济因素：一项多层次分析。
Socio-economic factors linked with mental health during the recession: a multilevel analysis.
作者信息
Ruiz-Pérez Isabel, Bermúdez-Tamayo Clara, Rodríguez-Barranco Miguel
机构信息
Escuela Andaluza de Salud Pública, Campus Universitario de Cartuja s/n, Granada, 18080, Spain.
CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain.
出版信息
Int J Equity Health. 2017 Mar 6;16(1):45. doi: 10.1186/s12939-017-0518-x.
BACKGROUND
Periods of financial crisis are associated with higher psychological stress among the population and greater use of mental health services. The objective is to analyse contextual factors associated with mental health among the Spanish population during the recession.
METHODOLOGY
Cross-sectional, descriptive study of two periods: before the recession (2006) and after therecession (2011-2012). The study population comprised individuals aged 16+ years old, polled for the National Health Survey. There were 25,234 subjects (2006) and 20,754 subjects (2012). The dependent variable was psychic morbidity.
INDEPENDENT VARIABLES
- socio-demographic (age, socio-professional class, level of education, nationality, employment situation, marital status), 2) psycho-social (social support) and 3) financial (GDP per capita, risk of poverty, income per capita per household), public welfare services (health spending per capita), labour market (employment and unemployment rates, percentage of temporary workers). Multilevel logistic regression models with mixed effects were constructed to determine change in psychic morbidity according to the variables studied.
RESULTS
The macroeconomic variables associated with worse mental health for both males and females were lower health spending per capita and percentage of temporary workers. Among women, the risk of poor mental health increased 6% for each 100€ decrease in healthcare spending per capita. Among men, the risk of poor mental health decreased 8% for each 5-percentage point increase in temporary workers.
CONCLUSIONS
Higher rates of precarious employment in a region have a negative effect on people's mental health; likewise lower health spending per capita. Policies during periods of recession should focus on support and improved conditions for vulnerable groups such as temporary workers. Healthcare cutbacks should be avoided in order to prevent increased prevalence of poor mental health.
背景
金融危机时期与民众更高的心理压力以及更多地使用心理健康服务相关。目的是分析衰退期间西班牙人口心理健康的相关背景因素。
方法
对两个时期进行横断面描述性研究：衰退前（2006年）和衰退后（2011 - 2012年）。研究人群包括16岁及以上接受全国健康调查的个体。2006年有25234名受试者，2012年有20754名受试者。因变量是精神疾病发病率。
自变量
1）社会人口统计学因素（年龄、社会职业阶层、教育程度、国籍、就业状况、婚姻状况），2）心理社会因素（社会支持），3）经济因素（人均国内生产总值、贫困风险、每户人均收入）、公共福利服务（人均医疗支出）、劳动力市场（就业率和失业率、临时工比例）。构建具有混合效应的多水平逻辑回归模型，以根据所研究的变量确定精神疾病发病率的变化。
结果
与男性和女性心理健康状况较差相关的宏观经济变量是人均医疗支出较低和临时工比例。在女性中，人均医疗保健支出每减少100欧元，心理健康状况不佳的风险增加6%。在男性中，临时工比例每增加5个百分点，心理健康状况不佳的风险降低8%。
结论
一个地区不稳定就业比例较高对人们的心理健康有负面影响；同样，人均医疗支出较低也有影响。衰退期间的政策应侧重于为临时工等弱势群体提供支持并改善其状况。应避免削减医疗保健支出，以防止心理健康状况不佳的患病率上升。
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