Wang Jing, Xu Minzhi, Fan Zina, Yin Xiaoxv, Xia Wenfei, Gong Yanhong
Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Breast and Thyroid surgery, Division of General Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, China.
J Affect Disord. 2025 Nov 15;389:119597. doi: 10.1016/j.jad.2025.119597. Epub 2025 Jun 4.
To explore the specific role and underlying mechanisms of lifestyles in the socioeconomic inequalities in depression.
A total of 299,310 participants from the UK Biobank were included. Cases of depression were identified based on electronic health records. Socioeconomic status (SES) was assessed using the Townsend Deprivation Index. Smoking, alcohol consumption, physical activity, sleep duration, leisure activities, dietary score, and obesity were used to construct the overall lifestyle risk score. Cox proportional hazard regression models, mediation and moderation analysis and multiple sensitivity analyses were used.
During a median follow-up of 8.94 years, 13,344 participants (4.46 %) developed depression. Compared with the highest SES group, the lower-middle and the lowest SES group had a 13 % (HR = 1.13, 95%CI: 1.08-1.19) and 49 % (HR = 1.49, 95%CI: 1.42-1.57) increased risk of depression, respectively. Lifestyles included in this study could explained approximately one-third of the socioeconomic disparity in depression. A significant interaction between lifestyle categories and SES were found (P < 0.01). In the groups with the highest, upper-middle, lower-middle, and lowest SES, participants with the least healthy lifestyle had a 50 % (HR = 1.50, 95%CI: 1.37-1.65), 53 % (HR = 1.53, 95%CI: 1.40-1.68), 73 % (HR = 1.73, 95%CI: 1.59-1.88), and 74 % (HR = 1.74, 95%CI: 1.62-1.86) increased risk of depression, respectively, compared to those with the healthiest lifestyle in the same SES category.
The association between SES and depression was significantly mediated by lifestyles. Reducing socio-economic inequalities is equally important as promoting healthy lifestyles among the population. Particular attention should be paid to the impoverished.
探讨生活方式在抑郁症社会经济不平等中的具体作用及潜在机制。
纳入英国生物银行的299310名参与者。根据电子健康记录确定抑郁症病例。使用汤森贫困指数评估社会经济地位（SES）。吸烟、饮酒、身体活动、睡眠时间、休闲活动、饮食评分和肥胖用于构建总体生活方式风险评分。采用Cox比例风险回归模型、中介和调节分析以及多重敏感性分析。
在中位随访8.94年期间，13344名参与者（4.46%）患上抑郁症。与最高SES组相比，中低收入组和最低SES组患抑郁症的风险分别增加了13%（HR = 1.13，95%CI：1.08 - 1.19）和49%（HR = 1.49，95%CI：1.42 - 1.57）。本研究纳入的生活方式可解释抑郁症社会经济差异的约三分之一。发现生活方式类别与SES之间存在显著交互作用（P < 0.01）。在最高、中高、中低和最低SES组中，与同SES类别中生活方式最健康的参与者相比，生活方式最不健康的参与者患抑郁症的风险分别增加了50%（HR = 1.50，95%CI：1.37 - 1.65）、53%（HR = 1.53，95%CI：1.40 - 1.68）、73%（HR = 1.73，95%CI：1.59 - 1.88）和74%（HR = 1.74，95%CI：1.62 - 1.86）。
SES与抑郁症之间的关联在很大程度上由生活方式介导。减少社会经济不平等与促进人群健康生活方式同样重要。应特别关注贫困人口。
