Does alleviating poverty affect mothers' depressive symptoms? A quasi-experimental investigation of Mexico's Oportunidades programme.
Does alleviating poverty affect mothers' depressive symptoms? A quasi-experimental investigation of Mexico's Oportunidades programme.
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DOI：
10.1093/ije/dyr103
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发表时间：
2011-12
影响因子：
7.7
通讯作者：
Emily J Ozer;L. Fernald;Ann Weber;Emily P Flynn;T. VanderWeele
中科院分区：
文献类型：
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作者：
Emily J Ozer;L. Fernald;Ann Weber;Emily P Flynn;T. VanderWeele
抑郁症是残疾的主要原因，特别是在妇女中;贫困增加了抑郁症的风险。除了直接影响外，母亲抑郁症还会损害儿童的健康和发育。本研究旨在评估墨西哥大规模反贫困计划（Oakidades）对孕产妇抑郁症状的影响。方法：2003年，对5050名生活在农村社区的妇女进行了评估，并与来自匹配社区的1293名妇女进行了比较，这些妇女的家庭在评估时没有接触过Ocluidades，但后来被招募。采用流行病学研究中心抑郁量表（CES-D）测量自我报告的抑郁症状。普通最小二乘回归被用来评估治疗效果的方案参与抑郁症，同时调整协变量和集群在社区一级。结果治疗组女性抑郁症状低于对照组（未校正的平均CES-D评分：16.9 ± 9.8 vs 18.6 ± 10.2）。在多变量分析中，在控制母亲年龄、教育和家庭人口统计学、种族和社会经济变量的同时，参与计划与较低的抑郁症相关[β= -1.7点，95%置信区间（95%CI）-2.46至-0.96，P < 0.001]。减少知觉压力和增加知觉控制调解人的方案对妇女的影响。结论：虽然奥沙利铂并不直接针对产妇的心理健康，但我们发现对抑郁症状有适度但有临床意义的影响。我们的设计允许更强的因果推理比观察性研究，已链接贫困和抑郁症状。我们的研究结果强调，个人的福祉是对宏观经济政策和方案的反应。
BACKGROUND Depression is a major cause of disability, particularly among women; poverty heightens the risk for depression. Beyond its direct effects, maternal depression can harm children's health and development. This study aimed to assess the effects of a large-scale anti-poverty programme in Mexico (Oportunidades) on maternal depressive symptoms. METHODS In 2003, 5050 women living in rural communities who had participated in Oportunidades since its inception were assessed and compared with a group of 1293 women from matched communities, whose families had received no exposure to Oportunidades at the time of assessment but were later enrolled. Self-reported depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CES-D). Ordinary least squares regressions were used to evaluate the treatment effect of programme participation on depression while adjusting for covariates and clustering at the community level. RESULTS Women in the treatment group had lower depressive symptoms than those in the comparison group (unadjusted mean CES-D scores: 16.9 ± 9.8 vs 18.6 ± 10.2). In multivariable analyses, programme participation was associated with lower depression whilst controlling for maternal age, education and household demographic, ethnicity and socio-economic variables [β= -1.7 points, 95% confidence interval (95% CI) -2.46 to -0.96, P < 0.001]. Reductions in perceived stress and increases in perceived control were mediators of programme effects on women. CONCLUSIONS Although Oportunidades did not target maternal mental health directly, we found modest but clinically meaningful effects on depressive symptoms. Our design permits stronger causal inference than observational studies that have linked poverty and depressive symptoms. Our results emphasize that the well-being of individuals is responsive to macro-level economic policies and programmes.