儿童社会经济地位及健康状况与晚年抑郁症状的关联：对2014/2015年印度尼西亚家庭生活调查的横断面潜在类别分析

Association of childhood socioeconomic status and health with depressive symptoms in later life: a cross-sectional latent class analysis of the 2014/2015 Indonesia Family Life Survey.

作者信息

Isnuwardana Ronny, Gibson Jonathan, Maharani Asri, Susanti Herni, Brooks Helen, Bee Penny, Anselmi Laura

机构信息

Laboratory of Public Health and Community Medicine, Mulawarman University, Samarinda, East Kalimantan, Indonesia.

Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK.

出版信息

BMJ Open. 2025 Aug 4;15(8):e095197. doi: 10.1136/bmjopen-2024-095197.

DOI:10.1136/bmjopen-2024-095197

PMID:40759526

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12323512/

Abstract

OBJECTIVES

While childhood circumstances predict mental health outcomes in high-income countries, evidence from low-income and middle-income countries (LMICs) like Indonesia remains scarce. This study examines the long-term association between childhood socioeconomic status (SES), health and depressive symptoms in adulthood, testing the hypothesis that early-life disadvantages increase the odds of depressive symptoms later in life.

DESIGN

Cross-sectional analysis using latent class analysis to cluster childhood SES/health and logistic regression to assess associations with depressive symptoms.

SETTING

A nationally representative household survey was conducted across 13 provinces in urban and rural areas of Indonesia.

PARTICIPANTS

32 085 adults aged 18 years and older from the 2014-2015 Indonesia Family Life Survey. Participants with missing data on childhood circumstances or depressive symptoms were excluded, resulting in a final analytic sample of 29 140 individuals.

OUTCOME MEASURES

The primary outcome was depressive symptoms measured using the 10-item Centre for Epidemiologic Studies Depression Scale, with scores ≥10 indicating clinically significant symptoms. Secondary exposures included latent classes of childhood SES and health (high, moderate and low disadvantage). Analyses adjusted for adult SES, health behaviours, social capital and demographic characteristics.

RESULTS

Three latent classes emerged: low (64.85%), moderate (5.73%) and high (29.42%) early-life disadvantage. Adjusted logistic regression showed higher odds of depressive symptoms for high (OR 1.39, 95% CI 1.28 to 1.50) and moderate disadvantage (OR 1.66, 95% CI 1.48 to 1.87) versus low. Significant covariates included age, education, wealth and social capital (all p<0.05).

CONCLUSIONS

Early-life disadvantages predict depressive symptoms in adulthood in Indonesia, underscoring the need for child-focused interventions (health, education and poverty reduction) to mitigate long-term mental health risks in LMICs. Further research should explore longitudinal mechanisms.

摘要

目标

虽然在高收入国家，儿童时期的环境能够预测心理健康结果，但来自印度尼西亚等低收入和中等收入国家（LMICs）的证据仍然很少。本研究考察了儿童社会经济地位（SES）、健康状况与成年期抑郁症状之间的长期关联，检验了早期生活劣势会增加后期出现抑郁症状几率的假设。

设计

采用潜在类别分析对儿童SES/健康状况进行聚类的横断面分析，并使用逻辑回归评估与抑郁症状的关联。

背景

在印度尼西亚城乡13个省份开展了一项具有全国代表性的家庭调查。

参与者

来自2014 - 2015年印度尼西亚家庭生活调查的32085名18岁及以上成年人。排除了在儿童时期情况或抑郁症状方面存在缺失数据的参与者，最终分析样本为29140人。

结局指标

主要结局是使用10项流行病学研究中心抑郁量表测量的抑郁症状，得分≥10表明存在具有临床意义的症状。次要暴露因素包括儿童SES和健康状况的潜在类别（高、中、低劣势）。分析对成人SES、健康行为、社会资本和人口特征进行了调整。

结果

出现了三个潜在类别：低（64.85%）、中（5.73%）和高（29.42%）早期生活劣势。调整后的逻辑回归显示，与低劣势相比，高劣势（比值比1.39，95%置信区间1.28至1.50）和中等劣势（比值比1.66，95%置信区间1.48至1.87）出现抑郁症状的几率更高。显著的协变量包括年龄、教育程度、财富和社会资本（均p<0.05）。