Longitudinal analysis of lifetime stressors and depression: Exploring intersectionality and tailoring social support for better mental health in a community population cohort

IF 4.9 2区 医学 Q1 CLINICAL NEUROLOGY
Xiangfei Meng , Muzi Li , Yingying Su , Jean Caron , Yu-Tao Xiang
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Abstract

Aims

Health inequalities studies need to understand how individuals simultaneously defined by several socioeconomic factors differ from others when facing a series of stressors across the lifespan in the risk of major depression (MD). Theoretical efforts, as well as empirical studies, have suggested a pertinent role of social support in mental health outcomes. However, little is known about which forms of social support would alleviate the negative impact of MD vulnerability in self-rated mental health (SRMH) across different socioeconomic groups. We investigated 1) differential associations between lifetime stressors and MD across social groups and 2) explored diverse social support forms mediating the associations between MD vulnerability and SRMH.

Methods

Data analyzed were from a large longitudinal population-based cohort. Multilevel analysis of individual heterogeneity and discriminatory accuracy was used to articulate MD vulnerability in different social groups defined by ethnicity, gender, and socioeconomic status (SES). Genetic predispositions were also included in the modeling process. These social groups were then regrouped based on their vulnerability level of MD. Mediation analyses were then applied to identify which social support forms mediate the effect of MD vulnerability on SRMH.

Results

Higher levels of stressors were associated with higher risks of MD, and their associations varied by different social groups. The social groups (White men with medium SES or White women with high SES) had the lowest predicted incidence of MD, whereas White women with low SES reported the highest predicted incidence of MD. Two social support forms (guidance and opportunity for nurturance) significantly mediated the indirect paths between MD vulnerability and SRMH.

Conclusions

By applying an intersectional lens, the present study provides a novel quantitative instrument for documenting the associations of stress and depression in various social identities. The findings of the study suggest more focused intervention programs and strategies for risk reduction should focus on identified characteristics and pay particular attention to the combined effect of lifetime stressors and discovered social identities.
终身压力源和抑郁的纵向分析:在社区人群队列中探索交叉性和定制社会支持以改善心理健康。
目的:健康不平等研究需要了解个体如何同时由几个社会经济因素定义与其他人不同,当面临一系列的压力源时,在整个生命周期的风险严重抑郁症(MD)。理论努力和实证研究都表明,社会支持在心理健康结果中发挥了相关作用。然而,在不同的社会经济群体中,哪种形式的社会支持会减轻MD脆弱性对自评心理健康的负面影响,我们知之甚少。本研究考察了1)不同社会群体中终生压力源与心理健康之间的差异关联,2)探索了不同社会支持形式在心理健康脆弱性与自评心理健康之间的中介作用。方法:数据分析来自一个大型的纵向人群队列。采用多水平的个体异质性和歧视性准确性分析来阐明由种族、性别和社会经济地位(SES)定义的不同社会群体的MD易感性。遗传倾向也包括在建模过程中。然后根据这些社会群体的MD脆弱性水平对其进行重新分组。然后应用中介分析来确定哪些社会支持形式介导了MD脆弱性对SRMH的影响。结果:较高水平的压力源与较高的MD风险相关,且其相关性因社会群体而异。中等社会地位的白人男性或高社会地位的白人女性的MD预测发病率最低,而低社会地位的白人女性的MD预测发病率最高。两种社会支持形式(指导和养育机会)在MD易感性与SRMH之间的间接通路中起着显著的中介作用。结论:本研究采用交叉视角,为记录不同社会身份的压力和抑郁之间的关系提供了一种新的定量工具。研究结果表明,更有针对性的干预计划和策略应该集中在已识别的特征上,并特别注意终身压力源和已发现的社会身份的综合影响。
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来源期刊
Journal of affective disorders
Journal of affective disorders 医学-精神病学
CiteScore
10.90
自引率
6.10%
发文量
1319
审稿时长
9.3 weeks
期刊介绍: The Journal of Affective Disorders publishes papers concerned with affective disorders in the widest sense: depression, mania, mood spectrum, emotions and personality, anxiety and stress. It is interdisciplinary and aims to bring together different approaches for a diverse readership. Top quality papers will be accepted dealing with any aspect of affective disorders, including neuroimaging, cognitive neurosciences, genetics, molecular biology, experimental and clinical neurosciences, pharmacology, neuroimmunoendocrinology, intervention and treatment trials.
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