Harrison J, Barrow S, Creed F
Manchester Royal Infirmary, UK.
Soc Psychiatry Psychiatr Epidemiol. 1998 Mar;33(3):124-8. doi: 10.1007/s001270050032.
Minor psychiatric morbidity is known to be associated with social disadvantage, but few studies have explored this association at the population level. This study reports data from a postal survey across 19 health districts in one region, with a total sample of 38,000 respondents. The percentage scoring above the General Health Questionnaire (GHQ) threshold for each health district was correlated with measures of deprivation derived from the 1991 census and standardised mortality ratios. Highly significant correlations were seen between the percentage above the GHQ threshold and the Underprivileged Area (UPA) score (r = 0.84), under 65 Standardised Mortality Ratio (SMR; r = 0.80), lack of amenities (r = 0.56), overcrowding (r = 0.54), lone-parent families (r = 0.84), unemployment (r = 0.87), unskilled workers (r = 0.77), ethnic minority composition (r = 0.58) and social mobility (r = 0.85). However, the three most deprived districts had the lowest response rates and when these were excluded from the analysis, only the correlations with under 65 SMR (r = 0.57, P < 0.05), UPA score (r = 0.52, P < 0.05) and unskilled workers (r = 0.60, P < 0.05) remained significant. There may be a threshold effect for the impact of social disadvantage on mental health, with much higher rates of psychological morbidity among markedly disadvantaged populations.
轻度精神疾病与社会弱势群体相关，这一点已为人所知，但很少有研究在人群层面探讨这种关联。本研究报告了来自某地区19个健康区的邮政调查数据，总样本为38000名受访者。每个健康区中得分高于一般健康问卷（GHQ）阈值的百分比与从1991年人口普查得出的贫困指标以及标准化死亡率相关。GHQ阈值以上的百分比与贫困地区（UPA）得分（r = 0.84）、65岁以下标准化死亡率（SMR；r = 0.80）、设施匮乏（r = 0.56）、过度拥挤（r = 0.54）、单亲家庭（r = 0.84）、失业（r = 0.87）、非技术工人（r = 0.77）、少数民族构成（r = 0.58）和社会流动性（r = 0.85）之间存在高度显著的相关性。然而，三个最贫困的区回复率最低，当将这些区排除在分析之外时，只有与65岁以下SMR（r = 0.57，P < 0.05）、UPA得分（r = 0.52，P < 0.05）和非技术工人（r = 0.60，P < 0.05）的相关性仍然显著。社会弱势群体对心理健康的影响可能存在阈值效应，在明显处于不利地位的人群中心理疾病发病率要高得多。
