University of British Columbia, Vancouver, and Arthritis Research Centre of Canada, Richmond, British Columbia, Canada.
University of California, San Francisco.
Arthritis Care Res (Hoboken). 2018 Jan;70(1):104-113. doi: 10.1002/acr.23247. Epub 2017 Dec 8.
To assess different measures of socioeconomic status (SES) as predictors of incident depression among women with systemic lupus erythematosus (SLE).
Data were derived from the 2010-2015 waves of the Lupus Outcomes Study, where individuals with confirmed SLE were interviewed annually by telephone. Depression was assessed using the Center for Epidemiologic Studies Depression Scale, using a validated lupus-specific cutoff (≥23) for major depressive disorder. Women interviewed in ≥2 consecutive waves, with scores <23 in the first wave (T1), were included. The level of financial strain was classified as high, moderate, or none based on responses to 3 questions. Generalized estimating equations were used to assess the impact of poverty status, income, education, and financial strain at T1 on the risk of incident depression the next year (T2), with adjustment for sociodemographic and disease status measures. Individuals could contribute more than one 2-year dyad to the analysis.
In total, 682 women contributed 2,097 observations, with 19% having high financial strain, 47% moderate strain, and 34% no strain. There were 166 women who had 184 episodes of incident depression (rate = 8.8/100 person-years). In bivariate analysis, poverty, lower income and education, disease activity, and high financial strain were associated with depression onset; race/ethnicity was not. Poverty, income, and education were not significant in multivariate analyses, but disease activity and high financial strain were (odds ratio 1.85 [95% confidence interval 1.06-3.23]).
High financial strain was a significant predictor of new-onset depression in women with SLE, controlling for disease factors and other SES measures. Determining specific, modifiable sources of financial strain may help prevent the development of depression.
评估不同社会经济地位（SES）指标作为系统性红斑狼疮（SLE）女性发生抑郁的预测因子。
数据来自 2010-2015 年狼疮结局研究的各波次，通过电话每年对确诊为 SLE 的个体进行访谈。使用流行病学研究中心抑郁量表（Center for Epidemiologic Studies Depression Scale）评估抑郁情况，采用狼疮特异性截断值（≥23）评估重度抑郁障碍。在至少 2 次连续波次中接受访谈，且首次波次（T1）评分<23 的女性纳入研究。根据对 3 个问题的回答，将财务压力水平分为高、中、无。使用广义估计方程评估 T1 时的贫困状况、收入、教育和财务压力对次年（T2）发生抑郁的风险的影响，同时调整社会人口统计学和疾病状况指标。个体可对分析贡献多个 2 年对。
共有 682 名女性贡献了 2097 个观察值，其中 19%的女性财务压力高，47%的女性压力中等，34%的女性没有压力。有 166 名女性发生了 184 次新发抑郁（发生率=8.8/100 人年）。在单变量分析中，贫困、较低收入和教育水平、疾病活动和高财务压力与抑郁发病相关；种族/民族无显著相关性。在多变量分析中，贫困、收入和教育水平不显著，但疾病活动和高财务压力显著（比值比 1.85[95%置信区间 1.06-3.23]）。
在控制疾病因素和其他 SES 指标后，高财务压力是 SLE 女性新发抑郁的重要预测因子。确定具体、可改变的财务压力源可能有助于预防抑郁的发生。
