Centre de Recherche en Epidémiologie et Santé des Populations (CESP), Institut National de la Santé et de la Recherche Médicale (INSERM) U1018, Villejuif, France.
IRIS, INSERM U997, Aubervilliers, France.
Int J Soc Psychiatry. 2024 Aug;70(5):874-887. doi: 10.1177/00207640241237714. Epub 2024 Mar 15.
While social disparities in depression are well-documented, the symptom experience across social positions remains less studied.
This study examines the connections between depressive symptoms and self-recognizing a depressive episode, on the one hand, and clinical diagnosis, on the other hand, by three social position indicators.
We analyzed baseline data from a population-based cohort of adults living in France, grouping participants by three indicators: education, financial difficulties, and occupation, and stratifying by sex. Utilizing a psychometric network approach, we estimated 24 networks. Nodes corresponded to the 20 CES-D items and 1 external variable, either 'Limitations due to depression' or 'Clinical depression'. Comparisons between socially disadvantaged and advantaged groups across the three social indicators were made in terms of network structures, global strength, and edge weights involving symptoms and both external nodes.
The study included data from 201,952 participants. Individuals in lower social positions exhibited higher rates of depressive-related variables. Four depressive symptoms emerged as crucial, being linked both to 'Clinical depression' and 'Limitations' across all social positions. Socially disadvantaged groups had denser networks. Some of the tests comparing network structures according to social position were significant, suggesting differences in the symptom activation chains. Connections between each external node and 'Felt depressed' and 'Could not get going' were non-invariant in educational and financial-based networks.
Findings highlight four depressive symptoms, likely to play a key role in the experience of depression across all social positions. Other insights from specific symptoms could be used for improving depression care among disadvantaged populations.
虽然抑郁症的社会差异已有充分记录，但社会地位对症状体验的影响仍研究不足。
本研究通过三种社会地位指标，一方面探讨抑郁症状与自我识别抑郁发作之间的关系，另一方面探讨其与临床诊断之间的关系。
我们分析了法国一项基于人群的成年人队列研究的基线数据，根据教育、经济困难和职业三种指标对参与者进行分组，并按性别分层。利用心理测量网络方法，我们估计了 24 个网络。节点对应于 20 项 CES-D 项目和 1 个外部变量，要么是“抑郁导致的限制”，要么是“临床抑郁症”。通过比较三个社会指标的社会劣势和优势群体之间的网络结构、整体强度和涉及症状和两个外部节点的边缘权重，来评估网络结构。
该研究共纳入 201952 名参与者。社会地位较低的个体表现出更高的抑郁相关变量发生率。四项抑郁症状被认为是至关重要的，它们与所有社会地位的“临床抑郁症”和“限制”都有关联。社会劣势群体的网络更为密集。根据社会地位比较网络结构的一些检验具有统计学意义，这表明在症状激活链方面存在差异。每个外部节点与“感到沮丧”和“无法振作”之间的联系在基于教育和经济的网络中并非不变。
研究结果强调了四项抑郁症状，它们可能在所有社会地位中对抑郁体验起到关键作用。从特定症状中获得的其他见解可用于改善弱势群体的抑郁护理。
