Choi Karmel W, Lee Younga H, Liu Zhaowen, Fatori Daniel, Bauermeister Joshua R, Luh Rebecca A, Clark Cheryl R, Brunoni André R, Bauermeister Sarah, Smoller Jordan W
Center for Precision Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.
Psychiatric & Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
medRxiv. 2022 May 16:2022.05.15.22274976. doi: 10.1101/2022.05.15.22274976.
Rates of depression have increased worldwide during the COVID-19 pandemic. One known protective factor for depression is social support, but more work is needed to quantify the extent to which social support could reduce depression risk during a global crisis, and specifically to identify which types of support are most helpful, and who might benefit most.
Data were obtained from participants in the Research Program who responded to the COVID-19 Participant Experience (COPE) survey administered monthly from May 2020 to July 2020 (N=69,066, 66% female). Social support was assessed using 10 items measuring emotional/informational support (e.g., someone to confide in or talk to about yourself or your problems), positive social interaction support (e.g., someone to do things with to help you get your mind off things), and tangible support (e.g., someone to help with daily chores if sick). Elevated depression symptoms were defined based on having a moderate-to-severe (≥10) score on the Patient Health Questionnaire (PHQ-9). Mixed-effects logistic regression models were used to test associations across time between overall social support and its subtypes with depression, adjusting for age, sex, race, ethnicity, and socioeconomic factors. We then assessed interactions between social support and potential effect modifiers: age, sex, pre-pandemic mood disorder, and pandemic-related stressors (e.g., financial insecurity).
Approximately 16% of the sample experienced elevated depressive symptoms. Overall social support was associated with significantly reduced odds of depression (adjusted odds ratio, aOR [95% CI]=0.44 [0.42-0.45]). Among subtypes, emotional/informational support (aOR=0.42 [0.41-0.43]) and positive social interactions (aOR=0.43 [0.41-0.44]) showed the largest protective associations with depression, followed by tangible support (aOR=0.63 [0.61-0.65]). Sex, age, and pandemic-related financial stressors were statistically significant modifiers of the association between social support and depression.
Individuals reporting higher levels of social support were at reduced risk of depression during the early COVID-19 pandemic. The perceived availability of emotional support and positive social interactions, more so than tangible support, was key. Individuals more vulnerable to depression (e.g., women, younger individuals, and those experiencing financial stressors) may particularly benefit from enhanced social support, supporting a precision prevention approach.
在新冠疫情期间，全球抑郁症发病率有所上升。社会支持是已知的抑郁症保护因素之一，但仍需开展更多工作来量化社会支持在全球危机期间降低抑郁症风险的程度，特别是要确定哪种类型的支持最有帮助，以及哪些人可能受益最大。
数据来自参与研究项目的参与者，他们对2020年5月至2020年7月每月进行的新冠疫情参与者体验（COPE）调查做出了回应（N = 69,066，66%为女性）。使用10个项目评估社会支持，这些项目测量情感/信息支持（例如，有人可以倾诉自己或自己的问题）、积极的社会互动支持（例如，有人可以一起做事情以帮助转移注意力）和实际支持（例如，生病时有人帮忙做家务）。根据患者健康问卷（PHQ - 9）得分中度至重度（≥10）来定义抑郁症状加重。使用混合效应逻辑回归模型来测试总体社会支持及其亚型与抑郁症随时间的关联，并对年龄、性别、种族、民族和社会经济因素进行调整。然后，我们评估了社会支持与潜在效应修饰因素之间的相互作用：年龄、性别、疫情前的情绪障碍和与疫情相关的压力源（例如，经济不安全）。
约16%的样本出现抑郁症状加重。总体社会支持与抑郁症几率显著降低相关（调整后的优势比，aOR [95%置信区间]=0.44 [0.42 - 0.45]）。在各亚型中，情感/信息支持（aOR = 0.42 [0.41 - 0.43]）和积极的社会互动（aOR = 0.43 [0.41 - 0.44]）与抑郁症的保护关联最大，其次是实际支持（aOR = 0.63 [0.61 - 0.65]）。性别、年龄和与疫情相关的经济压力源是社会支持与抑郁症关联的统计学显著修饰因素。
在新冠疫情早期，报告社会支持水平较高的个体患抑郁症的风险较低。情感支持和积极社会互动的可感知可用性比实际支持更关键。更容易患抑郁症的个体（例如，女性、年轻人和经历经济压力源的人）可能特别受益于增强的社会支持，这支持了精准预防方法。
