Brown Catherine R, Hambleton Ian R, Sobers-Grannum Natasha, Hercules Shawn M, Unwin Nigel, Nigel Harris E, Wilks Rainford, MacLeish Marlene, Sullivan Louis, Murphy Madhuvanti M
George Alleyne Chronic Disease Research Centre, Bridgetown, Barbados.
The University of the West Indies, Cave Hill, Barbados.
BMC Public Health. 2017 Jun 15;17(1):577. doi: 10.1186/s12889-017-4371-z.
Depressive disorder is the largest contributor to years lived with disability in the Caribbean, adding 948 per 100,000 in 2013. Depression is also a major risk factor for suicidal behaviour. Social inequalities influence the occurrence of depression, yet little is known about the social inequalities of this condition in the Caribbean. In support of the 2011 Rio Political Declaration on addressing health inequities, this article presents a systematic review of the role of social determinants on depression and its suicidal behaviours in the Caribbean.
Eight databases were searched for observational studies reporting associations between social determinants and depression frequency, severity, or outcomes. Based on the PROGRESS-plus checklist, we considered 9 social determinant groups (of 15 endpoints) for 6 depression endpoints, totalling 90 possible ways ('relationship groups') to explore the role of social determinants on depression. Studies with ≥50 participants conducted in Caribbean territories between 2004 and 2014 were eligible. The review was conducted according to STROBE and PRISMA guidelines. Results were planned as a narrative synthesis, with meta-analysis if possible.
From 3951 citations, 55 articles from 45 studies were included. Most were classified as serious risk of bias. Fifty-seven relationship groups were reported by the 55 included articles, leaving 33 relationship groups (37%) without an evidence base. Most associations were reported for gender, age, residence, marital status, and education. Depression, its severity, and its outcomes were more common among females (except suicide which was more common among males), early and middle adolescents (among youth), and those with lower levels of education. Marriage emerged as both a risk and protective factor for depression score and prevalence, while several inequality relationships in Haiti were in contrast to typical trends.
The risk of bias and few numbers of studies within relationship groups restricted the synthesis of Caribbean evidence on social inequalities of depression. Along with more research focusing on regional social inequalities, attempts at standardizing reporting guidelines for observational studies of inequality and studies examining depression is necessitated. This review offers as a benchmark to prioritize future research into the social determinants of depression frequency and outcomes in the Caribbean.
抑郁症是加勒比地区导致残疾生存年数增加的最大因素，2013年每10万人中有948人受其影响。抑郁症也是自杀行为的主要危险因素。社会不平等影响抑郁症的发生，但对于加勒比地区这种疾病的社会不平等情况却知之甚少。为支持2011年关于解决健康不平等问题的《里约政治宣言》，本文对社会决定因素在加勒比地区抑郁症及其自杀行为中的作用进行了系统综述。
检索了八个数据库，查找报告社会决定因素与抑郁症频率、严重程度或结局之间关联的观察性研究。基于PROGRESS-plus清单，我们针对6个抑郁症终点考虑了9个社会决定因素组（共15个端点），总共有90种可能途径（“关系组”）来探讨社会决定因素对抑郁症的作用。2004年至2014年期间在加勒比地区进行的、参与者≥50人的研究符合条件。该综述按照STROBE和PRISMA指南进行。结果计划进行叙述性综合分析，如有可能进行荟萃分析。
从3951条引用文献中，纳入了来自45项研究的55篇文章。大多数文章被归类为存在严重偏倚风险。纳入的55篇文章报告了57个关系组，剩下33个关系组（37%）没有证据支持。大多数关联涉及性别、年龄、居住地、婚姻状况和教育程度。抑郁症及其严重程度和结局在女性中更为常见（自杀除外，自杀在男性中更为常见）、在青少年早期和中期（青年群体中）以及教育程度较低者中更为常见。婚姻对抑郁症评分和患病率而言既是危险因素也是保护因素，但海地的一些不平等关系与典型趋势相反。
关系组中的偏倚风险和研究数量较少限制了对加勒比地区抑郁症社会不平等证据进行综合分析。除了开展更多关注区域社会不平等问题的研究外，还必须尝试规范不平等观察性研究以及抑郁症研究的报告指南。本综述为优先开展加勒比地区抑郁症频率和结局的社会决定因素的未来研究提供了一个基准。
