Reconsidering the Role of Social Disadvantage in Physical and Mental Health: Stressful Life Events, Health Behaviors, Race, and Depression
Reconsidering the Role of Social Disadvantage in Physical and Mental Health: Stressful Life Events, Health Behaviors, Race, and Depression
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DOI：
10.1093/aje/kwq283
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发表时间：
2010-12-11
影响因子：
5
通讯作者：
Jackson, James S.
中科院分区：
文献类型：
--
作者：
Mezuk, Briana;Rafferty, Jane A.;Jackson, James S.
抑郁症的患病率与社会经济地位的一些指标呈负相关，社会劣势的压力被假设为调解这种关系。相对于白人，黑人在大多数身体健康状况方面的负担更高，但出乎意料的是，抑郁症的负担更低。这项研究评估了一个病因学模型，整合心理和身体健康，以解释这种违反直觉的模式。巴尔的摩流行病学集水区研究（马里兰州，1993-2004）被用来评估压力和不良健康行为（吸烟，饮酒，不良饮食和肥胖）之间的相互作用和抑郁症的风险12年后的341名黑人和601名白人。在基线时，与白人相比，黑人从事更多不良健康行为，抑郁症患病率较低（5.9%对9.2%）。健康行为与压力之间的交互作用在白人中不显著（比值比（OR = 1.04，95%置信区间：0.98，1.11）;在黑人中，交互作用项显著且为负（β：-0.18，P < 0.014）。对于黑人来说，对于那些从事零（OR = 1.34）相对于1（OR = 1.12）和>= 2（OR = 0.94）不良健康行为的人，中位数压力和抑郁之间的关联更强。研究结果与提出的精神和身体健康差异模型一致。
Prevalence of depression is associated inversely with some indicators of socioeconomic position, and the stress of social disadvantage is hypothesized to mediate this relation. Relative to whites, blacks have a higher burden of most physical health conditions but, unexpectedly, a lower burden of depression. This study evaluated an etiologic model that integrates mental and physical health to account for this counterintuitive patterning. The Baltimore Epidemiologic Catchment Area Study (Maryland, 1993-2004) was used to evaluate the interaction between stress and poor health behaviors (smoking, alcohol use, poor diet, and obesity) and risk of depression 12 years later for 341 blacks and 601 whites. At baseline, blacks engaged in more poor health behaviors and had a lower prevalence of depression compared with whites (5.9% vs. 9.2%). The interaction between health behaviors and stress was nonsignificant for whites (odds ratio (OR = 1.04, 95% confidence interval: 0.98, 1.11); for blacks, the interaction term was significant and negative (beta: -0.18, P < 0.014). For blacks, the association between median stress and depression was stronger for those who engaged in zero (OR = 1.34) relative to 1 (OR = 1.12) and >= 2 (OR = 0.94) poor health behaviors. Findings are consistent with the proposed model of mental and physical health disparities.