收入和教育水平与一般人群中抑郁症状的升高有关：来自古腾堡健康研究的结果。
Income and education predict elevated depressive symptoms in the general population: results from the Gutenberg health study.
机构信息
Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Str. 8, 55131, Mainz, Germany.
Preventive Cardiology and Preventive Medicine, Department of Medicine II, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
出版信息
BMC Public Health. 2019 Apr 24;19(1):430. doi: 10.1186/s12889-019-6730-4.
BACKGROUND
Socioeconomic status (SES) has a strong association with depression or physical and mental health in general. However, as SES is a multifaceted construct these associations are not easy to explain. Further, there are several indicators and many studies only investigating two or less indicators at the same time. Therefore, this study aims to analyze the cross-sectional and longitudinal association of three defined SES dimensions (education, occupational position and household net-income) with the occurrence of elevated symptoms of depression relative to the impact of important covariates.
METHODS
The study included observational data from 12,484 participants of the Gutenberg Health Study. The outcome was "elevated depressive symptoms" as defined by Patient Health Questionnaire (PHQ-2) ≥ 2 at the 2.5-year follow-up. Regression coefficients were adjusted for baseline covariates (age, sex, partnership, depression, anxiety, medical history of depressive or anxiety disorder and major medical diseases (MMD)) in addition to SES sum score and the three single indicators. We further examined interaction terms of the SES with sex, partnership and major medical diseases. We analyzed the sample stratified by elevated depressive symptoms at baseline, as we expected different trajectories in both subgroups.
RESULTS
SES, education and household net-income were lower in the group of persons with PHQ-2 ≥ 2 at baseline, and they predicted the occurrence of PHQ-2 ≥ 2 at 2.5 year follow-up in the group of persons without elevated depressive symptoms at baseline after multivariable adjustment (SES: Odds Ratio (OR) 0.96, 0.95-0.98, p < 0.0001; education: OR 0.96, 0.93-0.99, p = 0.036; household net-income: OR 0.96, 0.92-0.99, p = 0.046) but not in the group of persons with elevated depressive symptoms at baseline. Further, we found that the impact of major medical diseases on the development of elevated depressive symptoms was buffered by high income. In addition, living in a partnership buffered the impact of a low occupational position.
CONCLUSIONS
Regarding the SES, the dimensions education and household net-income seem to play the most important role for socioeconomic inequalities in persons in Mid-West Germany with depressive symptoms.
TRIAL REGISTRATION
Reference no. 837.020.07; original vote: 22.3.2007, latest update: 20.10.2015.
背景
社会经济地位（SES）与抑郁或一般身心健康有很强的关联。然而，由于 SES 是一个多方面的结构，这些关联并不容易解释。此外，有几个指标，许多研究同时只调查两个或更少的指标。因此，本研究旨在分析三个定义的 SES 维度（教育、职业地位和家庭净收入）与发生抑郁症状升高的横断面和纵向关联，同时考虑到重要协变量的影响。
方法
本研究包括来自哥廷根健康研究的 12484 名参与者的观察性数据。结果是在 2.5 年随访时通过 PHQ-2 定义的“升高的抑郁症状”（PHQ-2≥2）。回归系数除 SES 总和和三个单一指标外，还针对基线协变量（年龄、性别、伴侣关系、抑郁、焦虑、抑郁或焦虑障碍的病史以及重大医疗疾病（MMD））进行了调整。我们进一步检查了 SES 与性别、伴侣关系和重大医疗疾病的交互项。我们根据基线时 PHQ-2≥2 的抑郁症状对样本进行了分层分析，因为我们预计这两个亚组会有不同的轨迹。
结果
在基线 PHQ-2≥2 的人群中，SES、教育和家庭净收入较低，并且在基线时没有升高的抑郁症状的人群中，这些因素预测了 2.5 年后 PHQ-2≥2 的发生。在多变量调整后（SES：优势比（OR）0.96，0.95-0.98，p<0.0001；教育：OR 0.96，0.93-0.99，p=0.036；家庭净收入：OR 0.96，0.92-0.99，p=0.046），但在基线时存在升高的抑郁症状的人群中没有预测。此外，我们发现重大医疗疾病对升高的抑郁症状发展的影响受到高收入的缓冲。此外，伴侣关系的存在缓冲了低职业地位的影响。
结论
就 SES 而言，在德国中西部有抑郁症状的人群中，教育和家庭净收入这两个维度似乎对社会经济不平等起着最重要的作用。
试验注册
参考号 837.020.07；原始投票：2007 年 3 月 22 日；最新更新：2015 年 10 月 20 日。
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