Zhai Xiaobing, Tong Henry H Y, Lam Chi Kin, Xing Abao, Sha Yuyang, Luo Gang, Meng Weiyu, Li Junfeng, Zhou Miao, Huang Yangxi, Wong Ling Shing, Wang Cuicui, Li Kefeng
Faculty of Applied Sciences, Macao Polytechnic University, Macau, Macau SAR.
Department of Radiology, Changzhi Medical College, Changzhi, China.
Nat Hum Behav. 2024 Dec;8(12):2392-2405. doi: 10.1038/s41562-024-02033-0. Epub 2024 Nov 4.
Depression represents a significant global public health challenge, and marital status has been recognized as a potential risk factor. However, previous investigations of this association have primarily focused on Western samples with substantial heterogeneity. Our study aimed to examine the association between marital status and depressive symptoms across countries with diverse cultural backgrounds using a large-scale, two-stage, cross-country analysis. We used nationally representative, de-identified individual-level data from seven countries, including the USA, the UK, Mexico, Ireland, Korea, China and Indonesia (106,556 cross-sectional and 20,865 longitudinal participants), representing approximately 541 million adults. The follow-up duration ranged from 4 to 18 years. Our analysis revealed that unmarried individuals had a higher risk of depressive symptoms than their married counterparts across all countries (pooled odds ratio, 1.86; 95% confidence interval (CI), 1.61-2.14). However, the magnitude of this risk was influenced by country, sex and education level, with greater risk in Western versus Eastern countries (β = 0.36; 95% CI, 0.16-0.56; P < 0.001), among males versus females (β = 0.25; 95% CI, 0.003-0.47; P = 0.047) and among those with higher versus lower educational attainment (β = 0.34; 95% CI, 0.11-0.56; P = 0.003). Furthermore, alcohol drinking causally mediated increased later depressive symptom risk among widowed, divorced/separated and single Chinese, Korean and Mexican participants (all P < 0.001). Similarly, smoking was as identified as a causal mediator among single individuals in China and Mexico, and the results remained unchanged in the bootstrap resampling validation and the sensitivity analyses. Our cross-country analysis suggests that unmarried individuals may be at greater risk of depression, and any efforts to mitigate this risk should consider the roles of cultural context, sex, educational attainment and substance use.
抑郁症是一项重大的全球公共卫生挑战，婚姻状况已被视为一个潜在风险因素。然而，此前对这种关联的调查主要集中在具有显著异质性的西方样本上。我们的研究旨在通过大规模、两阶段的跨国分析，考察不同文化背景国家中婚姻状况与抑郁症状之间的关联。我们使用了来自七个国家具有全国代表性的、经过去识别处理的个体层面数据，包括美国、英国、墨西哥、爱尔兰、韩国、中国和印度尼西亚（106,556名横断面参与者和20,865名纵向参与者），代表了约5.41亿成年人。随访时长从4年到18年不等。我们的分析显示，在所有国家中，未婚个体出现抑郁症状的风险高于已婚个体（合并比值比为1.86；95%置信区间[CI]为1.61 - 2.14）。然而，这种风险的程度受到国家、性别和教育水平的影响，西方国家的风险高于东方国家（β = 0.36；95% CI为0.16 - 0.56；P < 0.001），男性高于女性（β = 0.25；95% CI为0.003 - 0.47；P = 0.047），受教育程度高者高于受教育程度低者（β = 0.34；95% CI为0.11 - 0.56；P = 0.003）。此外，在中国、韩国和墨西哥的丧偶、离异/分居及单身参与者中，饮酒是导致后期抑郁症状风险增加的因果中介因素（所有P < 0.001）。同样，在中国和墨西哥，吸烟被确定为单身个体中的因果中介因素，在自助重抽样验证和敏感性分析中结果保持不变。我们的跨国分析表明，未婚个体可能患抑郁症的风险更高，任何减轻这种风险的努力都应考虑文化背景、性别、教育程度和物质使用的作用。
