Ribeiro Wagner Silva, Bauer Annette, Andrade Mário César Rezende, York-Smith Marianna, Pan Pedro Mario, Pingani Luca, Knapp Martin, Coutinho Evandro Silva Freire, Evans-Lacko Sara
Personal Social Service Research Unity, London School of Economics and Political Science, London, UK.
Personal Social Service Research Unity, London School of Economics and Political Science, London, UK.
Lancet Psychiatry. 2017 Jul;4(7):554-562. doi: 10.1016/S2215-0366(17)30159-1. Epub 2017 May 25.
Studies of the association between income inequality and mental health have shown mixed results, probably due to methodological heterogeneity. By dealing with such heterogeneity through a systematic review and meta-analysis, we examine the association between income inequality, mental health problems, use of mental health services, and resilience (defined as the ability to cope with adversity).
We searched the Global Health, PsychARTICLES, PsycINFO, Social Policy and Practice, Embase and MEDLINE databases up to July 6, 2016, for quantitative studies of the association of income inequality with prevalence or incidence of mental disorders or mental health problems, use of mental health services, and resilience. Eligible studies used standardised instruments at the individual level, and income inequality at the aggregated, contextual, and ecological level. We extracted study characteristics, sampling, exposure, outcomes, statistical modelling, and parameters from articles. Because several studies did not provide enough statistical information to be included in a meta-analysis, we did a narrative synthesis to summarise results with studies categorised as showing either a positive association, mixed results, or no association. The primary outcome in the random-effects meta-analysis was mental health-related morbidity, defined as the prevalence or incidence of any mental health problem. This study is registered with PROSPERO, number CRD42016036377.
Our search identified 15 615 non-duplicate references, of which 113 were deemed potentially relevant and were assessed for eligibility, leading to the inclusion of 27 studies in the qualitative synthesis. Nine articles found a positive association between income inequality and the prevalence or incidence of mental health problems; ten articles found mixed results, with positive association in some subgroups and non-significant or negative association in other subgroups; and eight articles found no association between income inequality and mental health problems. Of the nine articles included in our meta-analysis, one reported a positive association between income inequality and mental health problems, six reported mixed results, and two reported no association. Pooled Cohen's d effect sizes for the association between income inequality and any mental disorder or mental health problems were 0·06 (95% CI 0·01-0·11) for any mental disorder, and 0·12 (0·05-0·20) for depressive disorders. Our meta-regression analysis showed that none of the factors considered (sample size, contextual level at which income inequality was assessed, quality assessment, type of instruments, and individual income as control variable) explained heterogeneity between studies (I 89·3%; p<0·0001). Only one study investigated the association between income inequality and resilience; it found greater income inequality was associated with higher prevalence of depression only among individuals with low income. The only study of the role of income inequality as a determinant of the use of mental health services reported no association.
Income inequality negatively affects mental health but the effect sizes are small and there is marked heterogeneity among studies. If this association is causal and growing income inequality does lead to an increase in the prevalence of mental health problems, then its reduction could result in a significant improvement in population wellbeing.
None.
关于收入不平等与心理健康之间关联的研究结果不一，这可能是由于方法上的异质性所致。通过系统评价和荟萃分析来处理这种异质性，我们研究了收入不平等、心理健康问题、心理健康服务的使用以及心理韧性（定义为应对逆境的能力）之间的关联。
我们检索了截至2016年7月6日的Global Health、PsychARTICLES、PsycINFO、Social Policy and Practice、Embase和MEDLINE数据库，以查找关于收入不平等与精神障碍或心理健康问题的患病率或发病率、心理健康服务的使用以及心理韧性之间关联的定量研究。符合条件的研究在个体层面使用了标准化工具，并在汇总、背景和生态层面使用了收入不平等指标。我们从文章中提取了研究特征、抽样、暴露因素、结局、统计建模和参数。由于几项研究未提供足够的统计信息以纳入荟萃分析，我们进行了叙述性综合分析，以按显示正相关、结果不一或无关联对研究进行分类汇总结果。随机效应荟萃分析的主要结局是与心理健康相关的发病率，定义为任何心理健康问题的患病率或发病率。本研究已在国际前瞻性系统评价注册库（PROSPERO）注册，注册号为CRD42016036377。
我们的检索共识别出15615条非重复参考文献，其中113条被认为可能相关并进行了资格评估，最终有27项研究纳入定性综合分析。9篇文章发现收入不平等与心理健康问题的患病率或发病率之间存在正相关；10篇文章结果不一，在某些亚组中呈正相关，而在其他亚组中无显著关联或呈负相关；8篇文章发现收入不平等与心理健康问题之间无关联。在纳入我们荟萃分析的9篇文章中，1篇报告收入不平等与心理健康问题之间存在正相关，6篇报告结果不一，2篇报告无关联。收入不平等与任何精神障碍或心理健康问题之间关联的合并Cohen's d效应量，对于任何精神障碍为0.06（95%CI 0.01 - 0.11），对于抑郁症为0.12（0.05 - 0.20）。我们的荟萃回归分析表明，所考虑的因素（样本量、评估收入不平等的背景层面、质量评估、工具类型以及作为控制变量的个人收入）均无法解释研究之间的异质性（I² = 89.3%；p < 0.0001）。仅有1项研究调查了收入不平等与心理韧性之间的关联；该研究发现，仅在低收入个体中，收入不平等程度越高，抑郁症患病率越高。关于收入不平等作为心理健康服务使用决定因素的唯一一项研究报告无关联。
收入不平等对心理健康有负面影响，但效应量较小，且研究之间存在显著异质性。如果这种关联是因果关系，且收入不平等加剧确实导致心理健康问题患病率上升，那么减少收入不平等可能会显著改善人群健康状况。
无。
