社会经济地位与心理障碍相关性的多水平模型分析

A multilevel analysis on the association between socioeconomic status and psychiatric disorders

目的探讨社会经济地位（SES）与社区人群心理障碍的相关性。方法利用浙江省15岁以上人群精神病流行病学调查数据（n=14632），采用多水平logistic回归模型拟合个休SES维度（教育、收入、职业）和地理SES维度（居住地区）与心理障碍的相关性。心理障碍评定采用GHQ－12（分界值为3／4）。结果浙江省社区人群心理障碍的患病率为18．5％（95％CI：17．9％～19．1％），略高于河北省的16．7％（u=4．39，P〈0．001）。年家庭人均收入、职业等SES指标与心理障碍相关性较大；低收入组（相对于高收入组）OR=3．45，95％CI：1．72～6．67；无业／失业组（相对于非农业劳动者）OR=2．03，95％CI：1．73～2．40；心理障碍存县（市）水平具有集聚性，但作用较小；教育程度对心理障碍无影响。结论丰十区人群心理障碍与SES呈逆向梯度变化趋势，且主要与个体SES维度有关，地理SES维度（居住地区）有影响，但作用很小。

Objective To explore the association between psychiatric disorders and socioeconomic status such as education, income, employment and area of community settings in Zhejiang province. Methods Data were from the epidemiological survey of mental illnesses aged 15 and older in 2001 （n=14 632）. Psychiatric disorders were measured by GHQ-12 with a cut-point 4. Logistic multilevel analysis was the main statistical method being used. Results The overall prevalence of psychiatric disorders was 18.5% （95% confidence intervals, 17.9% to 19.1% ）, higher than the data from Hebei province （u=4.39, P〈0.001 ）. Annual household income and employment were strongly associated with psychiatric disorders especially for those with low income （odds ratio 3.45,95%CI： 1.72-6.67） and unemployment （odds ratio 2.03,95%CI： 1.73-2.40）. Factors as regional effect and education level showed weak or inconsistent association with psychiatric disorders alter controlling on other indicators. Conclusion Inverse gradient relation between psychiatric disorders and SES seemed as the main result of low SES individual characteristics and some minor effects at the county level.