目的:本研究旨在分析时间趋势,空间异质性,以及在全球21个疾病负担(GBD)地区,由于对妇女的亲密伴侣暴力(IPV)而导致的重度抑郁症(MDD)负担的潜在改善,从1990年到2019年,共有204个国家和地区。
方法:我们以每100,000人的残疾调整生命年(DALYs)来评估女性IPV引起的MDD负担,在20个年龄组和GBD地区,国家,和领土,使用2019年GBD研究的数据。DALY年龄标准化率(ASR)的平均年变化百分比(AAPC)用于反映一段时间的趋势。使用LOESS和分位数回归对五个GBD社会人口统计学指数(SDI)类别与DALYASR之间的关系进行建模。前沿分析确定了与发育状态相关的最小可实现DALYASR,以SDI衡量。
结果:尽管全球整体下降(AAPC-0.08[95%UI-0.2,0.03]),某些GBD地区,特别是高收入的北美和拉丁美洲中部,经历了DALYASR的增加。SDI和MDD负荷之间的关系表现出U型变异性,低SDI区域始终表现出较高且稳定的DALY率。前沿分析显示,几个国家,不管他们的SDI,在观察到的和潜在可实现的DALY率之间有很大的差距,指出有针对性干预的领域,以减轻IPV引起的MDD负担。
结论:从1990年到2019年,由于IPV导致的MDD在全球范围内发生了显着的时空异质性,突显了各国改善的巨大潜力。保护措施应定制以适应独特的文化背景,发展状态,以及每个国家的地区差异。
OBJECTIVE: This study aimed to analyze the temporal trends, spatial heterogeneities, and potential improvements in the burden of major depressive disorders (MDD) attributable to intimate partner violence (IPV) against women across 21 global burden of disease (GBD) regions, and 204 countries and territories from 1990 to 2019.
METHODS: We evaluated the burden of MDD attributable to IPV against women, as measured in disability-adjusted life years (DALYs) per 100,000 people across 21 GBD regions and 204 GBD countries and territories, using data from the 2019 GBD Study. The average annual percentage change (AAPC) of the DALY age-standardized rates (ASRs) was used to reflect trends over time. LOESS and quantile regression were used to model the relationship between the five GBD sociodemographic index (SDI) categories and DALY ASRs. Frontier analysis determined the minimum achievable DALY ASR associated with developmental status, as measured by the SDI.
RESULTS: The overall AAPC in age-standardized DALY rates for MDD attributable to IPV declined globally between 1990 and 2019. Despite the overall global decline (AAPC -0.08 [95 % UI -0.2, 0.03]), certain GBD regions, particularly high-income North America and Central Latin America, have experienced increases in DALY ASRs. The relationship between SDI and MDD burden showed a U-shaped variability, with low-SDI regions consistently exhibiting higher and stable DALY rates. Frontier analysis revealed that several countries, regardless of their SDI, have substantial gaps between observed and potentially achievable DALY rates, indicating areas for targeted intervention to reduce the burden of MDD due to IPV.
CONCLUSIONS: Significant spatial and temporal heterogeneity in MDD due to IPV was observed globally from 1990 to 2019, highlighting the substantial potential for improvement in various countries. Protective measures should be customized to suit the unique cultural contexts, developmental statuses, and regional disparities of each country.