PDF(Pubmed)
Abstract：
Most countries have witnessed a dramatic increase of income inequality in the past three decades. This paper addresses the question of whether income inequality is associated with the population prevalence of depression and, if so, the potential mechanisms and pathways which may explain this association. Our systematic review included 26 studies, mostly from high-income countries. Nearly two-thirds of all studies and five out of six longitudinal studies reported a statistically significant positive relationship between income inequality and risk of depression; only one study reported a statistically significant negative relationship. Twelve studies were included in a meta-analysis with dichotomized inequality groupings. The pooled risk ratio was 1.19 (95% CI: 1.07-1.31), demonstrating greater risk of depression in populations with higher income inequality relative to populations with lower inequality. Multiple studies reported subgroup effects, including greater impacts of income inequality among women and low-income populations. We propose an ecological framework, with mechanisms operating at the national level (the neo-material hypothesis), neighbourhood level (the social capital and the social comparison hypotheses) and individual level (psychological stress and social defeat hypotheses) to explain this association. We conclude that policy makers should actively promote actions to reduce income inequality, such as progressive taxation policies and a basic universal income. Mental health professionals should champion such policies, as well as promote the delivery of interventions which target the pathways and proximal determinants, such as building life skills in adolescents and provision of psychological therapies and packages of care with demonstrated effectiveness for settings of poverty and high income inequality.
摘要：
在过去的三十年中，大多数国家的收入不平等现象急剧增加。本文讨论了收入不平等是否与抑郁症的人口患病率相关的问题，如果是,可能解释这种关联的潜在机制和途径。我们的系统评价包括26项研究，主要来自高收入国家。所有研究中，近三分之二的研究和六项纵向研究中的五项报告了收入不平等与抑郁风险之间的统计学显着正相关；只有一项研究报告了统计学上显着的负相关关系。12项研究被纳入了二分不等式分组的荟萃分析。合并风险比为1.19(95%CI：1.07-1.31)，与收入不平等程度较低的人群相比，收入不平等程度较高的人群患抑郁症的风险更大。多项研究报告了亚组效应，包括妇女和低收入人群收入不平等的更大影响。我们提出了一个生态框架，机制在国家一级运作(新物质假说)，邻里水平（社会资本和社会比较假设）和个人水平（心理压力和社会失败假设）来解释这种关联。我们得出的结论是，政策制定者应该积极推动减少收入不平等的行动，例如累进税政策和基本的普遍收入。心理健康专业人员应该拥护这样的政策，以及促进针对途径和近端决定因素的干预措施的交付，例如在青少年中建立生活技能，提供心理治疗和一揽子护理，并证明对贫困和高收入不平等的环境有效。
