Smith Meghan L, Kakuhikire Bernard, Baguma Charles, Rasmussen Justin D, Perkins Jessica M, Cooper-Vince Christine, Venkataramani Atheendar S, Ashaba Scholastic, Bangsberg David R, Tsai Alexander C
Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
Mbarara University of Science and Technology, Mbarara, Uganda.
SSM Popul Health. 2019 Jul 7;8:100448. doi: 10.1016/j.ssmph.2019.100448. eCollection 2019 Aug.
Depression is a leading cause of disability worldwide, and has been found to be a consistent correlate of socioeconomic status (SES). The relative deprivation hypothesis proposes that one mechanism linking SES to health involves social comparisons, suggesting that relative SES rather than absolute SES is of primary importance in determining health status. Using data from a whole-population sample of 1,620 participants residing in rural southwestern Uganda, we estimated the independent associations between objective and subjective relative wealth and probable depression, as measured by the depression subscale of the Hopkins Symptom Checklist (HSCLD). Objective relative wealth was measured by an asset index based on information about housing characteristics and household possessions, which was used to rank study participants into quintiles (within each village) of relative household asset wealth. Subjective relative wealth was measured by a single question asking participants to rate their wealth, on a 5-point Likert scale, relative to others in their village. Within the population, 460 study participants (28.4%) screened positive for probable depression. Using Poisson regression with cluster-robust error variance, we found that subjective relative wealth was associated with probable depression, adjusting for objective relative wealth and other covariates (adjusted relative risk [aRR] comparing lowest vs. highest level of subjective relative wealth = 1.90, 95% confidence interval [CI]: 1.18, 3.06). Objective relative wealth was not associated with probable depression (aRR comparing lowest vs. highest quintile of objective relative wealth = 1.09, 95% CI: 0.77, 1.55). These results suggest that, in this context, subjective relative wealth is a stronger correlate of mental health status compared with objective relative wealth. Our findings are potentially consistent with the relative deprivation hypothesis, but more research is needed to explain how relative differences in wealth are (accurately or inaccurately) perceived and to elucidate the implications of these perceptions for health outcomes.
抑郁症是全球导致残疾的主要原因，并且一直被发现与社会经济地位（SES）密切相关。相对剥夺假说提出，将社会经济地位与健康联系起来的一种机制涉及社会比较，这表明在决定健康状况方面，相对社会经济地位而非绝对社会经济地位至关重要。我们使用来自乌干达西南部农村地区1620名参与者的全人群样本数据，估计了客观和主观相对财富与可能的抑郁症之间的独立关联，抑郁症通过霍普金斯症状清单（HSCLD）的抑郁分量表进行测量。客观相对财富通过基于住房特征和家庭财产信息的资产指数来衡量，该指数用于将研究参与者按相对家庭资产财富的五分位数（在每个村庄内）进行排名。主观相对财富通过一个单一问题来衡量，该问题要求参与者在5点李克特量表上对自己相对于同村其他人的财富进行评分。在该人群中，460名研究参与者（28.4%）筛查出可能患有抑郁症呈阳性。使用具有聚类稳健误差方差的泊松回归，我们发现主观相对财富与可能的抑郁症相关，在调整了客观相对财富和其他协变量后（比较主观相对财富最低水平与最高水平的调整相对风险[aRR]=1.90，95%置信区间[CI]：1.18，3.06）。客观相对财富与可能的抑郁症无关（比较客观相对财富最低五分位数与最高五分位数的aRR=1.09，95%CI：0.77，1.55）。这些结果表明，在这种情况下，与客观相对财富相比，主观相对财富与心理健康状况的相关性更强。我们的研究结果可能与相对剥夺假说一致，但需要更多研究来解释财富的相对差异是如何（准确或不准确地）被感知的，并阐明这些感知对健康结果的影响。
