Poverty and common mental disorders in low and middle income countries: A systematic review.
Poverty and common mental disorders in low and middle income countries: A systematic review.
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DOI：
10.1016/j.socscimed.2010.04.027
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发表时间：
2010-08
期刊：
影响因子：
--
通讯作者：
Patel V
中科院分区：
文献类型：
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作者：
Lund C;Breen A;Flisher AJ;Kakuma R;Corrigall J;Joska JA;Swartz L;Patel V
尽管低收入和中等收入国家（LMIC）的贫困水平很高，普通精神障碍（CMD）造成的负担很重，但只有在过去的二十年里，才出现了研究，以经验为基础解决了这些国家贫困和CMD之间的关系。我们对LMIC的流行病学文献进行了系统回顾，目的是研究这种关系。在审查的115项研究中，大多数报告了一系列贫困指标与CMD之间的正相关。在以社区为基础的研究中，分别使用双变量和多变量分析，73%和79%的研究报告了各种贫困措施与CMD之间的正相关，19%和15%报告了零相关，8%和6%报告了负相关。然而，对具体的贫穷问题进行更仔细的审查后发现，情况很复杂，这些问题之间有很大的差异。虽然教育、粮食不安全、住房、社会阶层、社会经济地位和财政压力等变量与CMD表现出相对一致和强烈的关联，但收入、就业、特别是消费等其他变量则更为模糊。有几个衡量和人口因素可以解释贫困与社区发展之间关系强度的变化。通过对文献的系统回顾，本文试图将辩论从贫困是否与LMIC中的CMD相关的问题转移到贫困的哪些特定方面具有最强（或最弱）关联的问题。在低收入国家中，CMD与各种贫困层面之间相对一致的关联有助于加强将心理健康纳入发展机构议程和千年发展目标等国际目标的理由。
In spite of high levels of poverty in low and middle income countries (LMIC), and the high burden posed by common mental disorders (CMD), it is only in the last two decades that research has emerged that empirically addresses the relationship between poverty and CMD in these countries. We conducted a systematic review of the epidemiological literature in LMIC, with the aim of examining this relationship. Of 115 studies that were reviewed, most reported positive associations between a range of poverty indicators and CMD. In community-based studies, 73% and 79% of studies reported positive associations between a variety of poverty measures and CMD, 19% and 15% reported null associations and 8% and 6% reported negative associations, using bivariate and multivariate analyses respectively. However, closer examination of specific poverty dimensions revealed a complex picture, in which there was substantial variation between these dimensions. While variables such as education, food insecurity, housing, social class, socio-economic status and financial stress exhibit a relatively consistent and strong association with CMD, others such as income, employment and particularly consumption are more equivocal. There are several measurement and population factors that may explain variation in the strength of the relationship between poverty and CMD. By presenting a systematic review of the literature, this paper attempts to shift the debate from questions about whether poverty is associated with CMD in LMIC, to questions about which particular dimensions of poverty carry the strongest (or weakest) association. The relatively consistent association between CMD and a variety of poverty dimensions in LMIC serves to strengthen the case for the inclusion of mental health on the agenda of development agencies and in international targets such as the millenium development goals.