Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, USA.
Center for Preventive Medical Sciences, Chiba University, Chiba, Japan; Department of Gerontological Evaluation, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan.
Soc Sci Med. 2017 Sep;189:138-144. doi: 10.1016/j.socscimed.2017.07.028. Epub 2017 Aug 3.
Income is hypothesized to affect health not just through material pathways (i.e., the ability to purchase health-enhancing goods) but also through psychosocial pathways (e.g., social comparisons with others). Two concepts relevant to the psychosocial effects of income are: relative deprivation (for example expressed by the Yitzhaki Index, measuring the magnitude of difference in income among individuals) and Income Rank. This study examined whether higher relative deprivation and lower income rank are associated with depressive symptoms in an older population independently of absolute income.
Using cross-sectional data of 83,100 participants (40,038 men and 43,062 women) in the Japan Gerontological Evaluation Study (JAGES), this study applied multiple logistic regression models to calculate the odds ratios (OR) of depression associated with relative deprivation/Income Rank. The Japanese Geriatric Depression Scale (GDS-15) was used to assess depressive symptoms, and subjects with a score of ≥5 were categorized as depressed. Reference groups for calculating the Yitzhaki Index and income rank were constructed based on same gender, age-group, and municipality of residence.
The findings indicated that after controlling for demographic factors, each 100,000 yen increase in relative deprivation and 0.1 unit decrease in relative rank was associated with a 1.07 (95% CI = 1.07, 1.08) and a 1.15 (95% CI = 1.14, 1.16) times higher odds of depression, respectively, in men. The corresponding ORs in women were 1.05 (95% CI = 1.05, 1.06) and 1.12 (95% CI = 1.11, 1.13), respectively. After adjustment for other covariates and stratification by income quartiles, the results remained statistically significant. Women in the highest income quartile appeared to be more susceptible to the adverse mental health effects of low income rank, while among men the associations were reversed. Low income rank appeared to be more toxic for the poor.
Concepts of relative income appear to be relevant for mental health over and above the effects of absolute income.
收入不仅通过物质途径（即购买有益于健康的商品的能力），而且通过心理社会途径（例如与他人的社会比较）影响健康。与收入的心理社会影响相关的两个概念是：相对剥夺（例如，通过伊扎基指数来表示，该指数衡量个体之间收入差异的程度）和收入等级。本研究在一个老年人群中，检验了在考虑到绝对收入的情况下，较高的相对剥夺和较低的收入等级是否与抑郁症状独立相关。
使用日本老年评估研究（JAGES）中 83100 名参与者（40038 名男性和 43062 名女性）的横断面数据，本研究应用多因素逻辑回归模型计算与相对剥夺/收入等级相关的抑郁的优势比（OR）。使用日本老年抑郁量表（GDS-15）评估抑郁症状，得分≥5 的患者被归类为抑郁。为了计算伊扎基指数和收入等级，构建了基于相同性别、年龄组和居住地的参考组。
结果表明，在控制了人口统计学因素后，相对剥夺每增加 100,000 日元和相对等级每降低 0.1 个单位，男性患抑郁的几率分别增加 1.07（95%CI=1.07,1.08）和 1.15（95%CI=1.14,1.16）倍。女性的相应 OR 分别为 1.05（95%CI=1.05,1.06）和 1.12（95%CI=1.11,1.13）。在调整了其他协变量并按收入四分位数分层后，结果仍具有统计学意义。收入最高四分位数的女性似乎更容易受到低收入等级对心理健康的不利影响，而男性则相反。低收入等级对穷人来说似乎更具毒性。
相对收入的概念似乎与心理健康有关，而不仅仅是绝对收入的影响。
