Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa; Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom.
Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, South Africa.
J Affect Disord. 2018 Mar 15;229:396-402. doi: 10.1016/j.jad.2017.12.050. Epub 2017 Dec 28.
Two theories have been proposed to explain the observed association between depression and poverty, namely social causation and social drift. Little is known regarding the relative importance of social causation and social drift in low and middle-income countries, where poverty is more severe and where most of the world's depressed individuals live.
We analysed nationally representative longitudinal data from the National Income Dynamics Study in South Africa and simultaneously tested social causation and social drift hypotheses using structural equation modelling across three waves.
Worse individual economic status at time 1 and 2 was independently associated with worse depression two years later at time 2 (standardised linear regression coefficient β = -0.110, Standard Error (SE): 0.024) and four years later at time 3 (β = -0.113, SE: 0.025) respectively. Conversely worse depression at time 1 and time 2 was independently associated with worse economic status at time 2 (β = -0.037, SE: 0.016) and time 3 (β = -0.028, SE: 0.012) respectively. In addition, the "effect" of depression on future assets was stronger among people with less baseline assets.
The time span between data rounds is relatively short (four years); response rates are unequal across ethnic, age and sex groups; and the measure of depression is based on self-report.
Social causation and social drift act simultaneously in this population, reinforcing poverty/depression cycles. Multi-sectoral policies are required that both prevent depression by addressing its economic determinants, and provide evidence-based treatment to mitigate the economic impact of depression.
有两种理论被提出用来解释抑郁和贫困之间的观察到的关联，即社会因果关系和社会漂流。在贫困更为严重且世界上大多数抑郁症患者生活的中低收入国家，关于社会因果关系和社会漂流的相对重要性知之甚少。
我们分析了南非国家收入动态研究的全国代表性纵向数据，并使用结构方程模型在三个时间点同时检验了社会因果关系和社会漂流假说。
在时间 1 和 2 时个体经济状况较差与两年后时间 2 时抑郁症状加重（标准化线性回归系数β=-0.110，标准误[SE]：0.024）和四年后时间 3 时抑郁症状加重（β=-0.113，SE：0.025）独立相关。相反，在时间 1 和时间 2 时抑郁症状加重与在时间 2（β=-0.037，SE：0.016）和时间 3（β=-0.028，SE：0.012）时经济状况较差独立相关。此外，在基线资产较少的人群中，抑郁对未来资产的“影响”更强。
数据轮次之间的时间跨度相对较短（四年）；不同种族、年龄和性别群体的回复率不平等；抑郁的衡量标准基于自我报告。
在该人群中，社会因果关系和社会漂流同时起作用，加剧了贫困/抑郁的循环。需要采取多部门政策，通过解决其经济决定因素来预防抑郁，并提供基于证据的治疗方法来减轻抑郁对经济的影响。
