Kohler Iliana V, Payne Collin F, Bandawe Chiwoza, Kohler Hans-Peter
Population Studies Center and Department of Sociology, University of Pennsylvania, Philadelphia, PA, 19104, USA.
Harvard Center for Population and Development Studies, Cambridge, MA, 02138, USA.
Demography. 2017 Aug;54(4):1529-1558. doi: 10.1007/s13524-017-0596-9.
Very few studies have investigated mental health in sub-Saharan Africa (SSA). Using data from Malawi, this article provides a first picture of the demography of depression and anxiety (DA) among mature adults (aged 45 or older) in a low-income country with high HIV prevalence. DA are more frequent among women than men, and individuals affected by one are often affected by the other. DA are associated with adverse outcomes, such as poorer nutrition intake and reduced work efforts. DA also increase substantially with age, and mature adults can expect to spend a substantial fraction of their remaining lifetime-for instance, 52 % for a 55-year-old woman-affected by DA. The positive age gradients of DA are not due to cohort effects, and they are in sharp contrast to the age pattern of mental health that has been shown in high-income contexts, where older individuals often experience lower levels of DA. Although socioeconomic and risk- or uncertainty-related stressors are strongly associated with DA, they do not explain the positive age gradients and gender gap in DA. Stressors related to physical health, however, do. Hence, our analyses suggest that the general decline of physical health with age is the key driver of the rise of DA with age in this low-income SSA context.
很少有研究调查撒哈拉以南非洲地区（SSA）的心理健康状况。本文利用马拉维的数据，首次描绘了一个艾滋病毒高流行率的低收入国家中成熟成年人（45岁及以上）的抑郁和焦虑（DA）人口统计学情况。女性中的DA比男性更常见，且受其中一种影响的个体往往也受另一种影响。DA与不良后果相关，如营养摄入较差和工作效率降低。DA也随着年龄大幅增加，成熟成年人可能预期在其剩余寿命的很大一部分时间——例如，一名55岁女性的52%——受DA影响。DA的正向年龄梯度并非由队列效应导致，且与高收入背景下所显示的心理健康年龄模式形成鲜明对比，在高收入背景下，老年人的DA水平往往较低。尽管社会经济以及与风险或不确定性相关的压力源与DA密切相关，但它们并不能解释DA的正向年龄梯度和性别差异。然而，与身体健康相关的压力源可以解释。因此，我们的分析表明，在这个低收入的撒哈拉以南非洲地区背景下，身体健康状况随年龄的普遍下降是DA随年龄上升的关键驱动因素。
