Sajjadi Homeira, Harouni Gholamreza Ghaedamini, Rafiey Hassan, Vaez-Mahdavi Mohammadreza, Vameghi Meroe, Mohaqeqi Kamal Seyed Hossein
Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
J Prev Med Public Health. 2020 May;53(3):189-197. doi: 10.3961/jpmph.19.150. Epub 2020 Apr 14.
Our aim was to answer the following questions: (1) Can mental health variance be partitioned to individual and higher levels (e.g., neighborhood and district); (2) How much (as a percentage) do individual-level determinants explain the variability of mental health at the individual-level; and (3) How much do determinants at the neighborhood- or district-level explain the variability of mental health at the neighborhood- or district-level?
We used raw data from the second round of the Urban Health Equity Assessment and Response Tool in Tehran (in 2012-2013, n=34 700 samples nested in 368 neighborhoods nested in 22 districts) and the results of the official report of Tehran's Center of Studies and Planning (in 2012-2013, n=22 districts). Multilevel linear regression models were used to answer the study questions.
Approximately 40% of Tehran residents provided responses suggestive of having mental health disorders (30-52%). According to estimates of residual variance, 7% of mental health variance was determined to be at the neighborhood-level and 93% at the individual-level. Approximately 21% of mental health variance at the individual-level and 49% of the remaining mental health variance at the neighborhood-level were determined by determinants at the individual-level and neighborhood-level, respectively.
If we want to make the most effective decisions about the determinants of mental health, in addition to considering the therapeutic perspective, we should have a systemic or contextual view of the determinants of mental health.
我们的目标是回答以下问题：（1）心理健康差异能否被划分为个体层面和更高层面（如社区和行政区）；（2）个体层面的决定因素在个体层面上能解释心理健康变异性的多少（以百分比表示）；以及（3）社区或行政区层面的决定因素在社区或行政区层面上能解释心理健康变异性的多少？
我们使用了德黑兰城市健康公平评估与应对工具第二轮的原始数据（2012 - 2013年，34700个样本嵌套于368个社区，这些社区又嵌套于22个行政区）以及德黑兰研究与规划中心官方报告的结果（2012 - 2013年，22个行政区）。采用多水平线性回归模型来回答研究问题。
大约40%的德黑兰居民给出的回答表明存在心理健康障碍（30% - 52%）。根据残差方差估计，7%的心理健康差异被确定为在社区层面，93%在个体层面。个体层面约21%的心理健康差异以及社区层面剩余心理健康差异的49%分别由个体层面和社区层面的决定因素所决定。
如果我们想就心理健康的决定因素做出最有效的决策，除了考虑治疗角度外，我们还应该对心理健康的决定因素有一个系统的或背景性的认识。
