Studies addressing social resources.

We conducted a systematic review to examine whether changes in social determinants can contribute to the prevention of depression, in order to provide input for policy development and to highlight research gaps. Social determinants were defined as the structural conditions in which people live that shape their health and were categorized according to whether they pertained to societal arrangements, material resources distributed through these arrangements, or social resources that follow from interactions between people. To capture all relevant evidence we included studies that measured depressive disorders, depressive symptoms, psychological distress, mental health and prescription rates of antidepressants. We searched three databases (Medline, Embase and Psychinfo) from their inception till December 2022 and supplemented our search by reference and citation searching of the included studies. Studies were synthesized qualitatively and we used the Validity Assessment tool for econometric studies to assess study quality. Prospero submission number CRD42021236132 A total of 31,103 titles were identified, 135 studies met our inclusion criteria. The majority of studies were conducted in the United States (n = 45) or the United Kingdom (n = 39). Studies used longitudinal data (n = 61); repeated cross-sectional data (n = 20); or evaluated an intervention study (n = 7). Study designs included natural experiments (n = 19), while some used propensity score matching to construct a quasi-experiment (n = 11). Analysis methods included difference-in-difference approaches (n = 30) or regression analysis in varying forms. We found evidence that strategies that promote paid employment and parental leave policies can reduce risk of depression whereas reduced entitlements to social welfare (particularly when accompanied by obligations to enter employment), loss of income, instability of housing and collective insecurity increase depression risk. A number of studies examined moderation by gender, age category or ethnicity and of these gender was the most commonly observed moderator. Few studies tested underlying causal mechanisms with formal mediation analyses. These studies provide important indications of how intervening on social determinants of health can shape risk for depression. However, the included studies do not fully capture the complexity of the relationships between determinants and the mechanisms driving them. Future studies could take this into account, for instance by using systems approaches.

本研究开展了一项系统综述，旨在探讨社会决定因素（social determinants）的变化是否有助于抑郁症预防，以期为政策制定提供参考，并明确现有研究的空白领域。社会决定因素被定义为影响个体健康的生存结构性条件，并根据其所属范畴分为三类：涉及社会制度安排、通过该类安排分配的物质资源，以及源于人际互动的社会资源。为全面纳入相关研究证据，本综述纳入了评估抑郁障碍、抑郁症状、心理困扰、心理健康状况以及抗抑郁药处方率的相关研究。本研究检索了Medline、Embase及Psychinfo三个数据库，检索时限为各数据库建库至2022年12月，并通过对纳入研究的参考文献及被引文献进行检索以补充检索范围。研究采用定性合成方法进行整合，并使用计量研究有效性评估工具（Validity Assessment tool for econometric studies）对研究质量进行评价。本系统综述已在PROSPERO平台注册，注册号为CRD42021236132。本次检索共识别出31103条文献题录，最终有135项研究符合纳入标准。纳入研究大部分在美国（n=45）或英国（n=39）开展。研究数据类型包括纵向数据（n=61）、重复横断面数据（n=20），或为干预研究评估（n=7）。研究设计涵盖自然实验（n=19），部分研究采用倾向得分匹配（propensity score matching）构建准实验框架（n=11）。分析方法包括双重差分法（difference-in-difference approaches，n=30）及多种形式的回归分析。本综述发现，促进有偿就业与实施育儿休假政策的相关策略可降低抑郁风险；而社会福利权益缩减（尤其是伴随就业参与义务的情况）、收入损失、住房不稳定及集体性不安全感则会提升抑郁发生风险。多项研究探讨了性别、年龄组别或种族对关联的调节作用，其中性别是最常被考察的调节变量。仅有少量研究通过正式的中介分析检验了潜在的因果机制。上述研究为通过干预健康社会决定因素以调控抑郁风险提供了重要启示。但纳入的研究未能充分揭示社会决定因素间关联的复杂性及其驱动机制。未来研究可考虑采用系统论方法等途径对此进行完善。