在常见精神障碍患者治疗方面的社会经济不平等与后续精神疾病发展的关系。
Socioeconomic inequalities in treatment of individuals with common mental disorders regarding subsequent development of mental illness.
作者信息
Dorner Thomas E, Mittendorfer-Rutz Ellenor
机构信息
Centre for Public Health, Department for Social and Preventive Medicine, Medical University of Vienna, Vienna, Austria.
Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
出版信息
Soc Psychiatry Psychiatr Epidemiol. 2017 Aug;52(8):1015-1022. doi: 10.1007/s00127-017-1389-6. Epub 2017 May 11.
PURPOSE
Socioeconomic differences appear to be reflected in both, the development and the treatment of common mental disorders (CMDs, i.e. depressive, anxiety and stress-related disorders). Underlying mechanisms of these inequalities are to date not fully understood. This study aimed to investigate if (1) there are socioeconomic differences with regard to type of treatment and (2) if the socioeconomic status modifies the association between treatment and subsequent inpatient care or suicide attempt, respectively, in individuals with CMDs.
METHODS
The study population comprised 66,097 individuals aged 18-59 on sick-leave due to a CMD during 2006 in Sweden. Cox regression with a follow-up from 2007 through 2010 estimated crude and multivariate hazard ratios (HR) with 95% confidence intervals (CI).
RESULTS
Individuals with sickness absence due to CMDs and a higher educational level were had a lower proportions of specialised health care and combined psychiatric medication than their counterparts with lower education. However, if high educated CMD patients received more combined medication, associations with subsequent mental inpatient care (p < 0.01) and suicide attempt (p < 0.05) were stronger than for their counterparts with low education. Moreover, previous inpatient care due to mental disorders was associated with higher HRs of subsequent suicide attempt in CMD patients with high education (HR 5.88; CI 3.02-11.45) compared to those with low education (1.96; 1.06-3.60).
CONCLUSION
Findings suggest that socioeconomic inequalities shape differences in treatment measures and mental health development in individuals with CMDs. These differences might signal discrepancies in treatment per se or reflect morbidity differences requiring different treatment regimens, or may be due to the fact that different diagnoses are given in different educational strata due to differential role of stigma.
目的
社会经济差异似乎在常见精神障碍（即抑郁、焦虑和与压力相关的障碍）的发展和治疗中均有体现。这些不平等现象的潜在机制目前尚未完全明确。本研究旨在调查：（1）在治疗类型方面是否存在社会经济差异；（2）社会经济地位是否分别改变了患有常见精神障碍的个体接受治疗与随后住院治疗或自杀未遂之间的关联。
方法
研究人群包括2006年在瑞典因常见精神障碍而休病假的66,097名18至59岁的个体。采用Cox回归分析，随访时间为2007年至2010年，估计粗风险比和多变量风险比（HR）以及95%置信区间（CI）。
结果
因常见精神障碍而缺勤且教育水平较高的个体，与教育水平较低的个体相比，接受专科医疗保健和联合使用精神科药物的比例较低。然而，如果高学历的常见精神障碍患者使用更多的联合药物治疗，那么与随后的精神科住院治疗（p < 0.01）和自杀未遂（p < 0.05）的关联比低学历患者更强。此外，与低学历的常见精神障碍患者（1.96；1.06 - 3.60）相比，高学历的常见精神障碍患者因精神障碍既往住院治疗与随后自杀未遂的风险比更高（HR 5.88；CI 3.02 - 11.45）。
结论
研究结果表明，社会经济不平等塑造了患有常见精神障碍个体在治疗措施和心理健康发展方面的差异。这些差异可能表明治疗本身存在差异，或者反映了需要不同治疗方案的发病率差异，也可能是由于耻辱感的不同作用导致不同教育阶层给予不同诊断。
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