摘要目的 研究中国30~79岁成年人负性生活事件与抑郁关联的性别差异.方法 对来自中国慢性病前瞻性研究项目基线调查的512891名研究对象进行分析.采用多元logistic回归模型,分别计算男、女性经历3类(家庭相关、经济相关和其他)10项负性生活事件(SLEs)与抑郁之间的相对风险比(RRR)及其95%CI,计算经历SLEs数量与抑郁之间的剂量反应关系;并探索性别在SLEs与抑郁之间的效应修饰作用.结果 家庭相关事件、经济相关事件和其他事件3类SLEs的发生率为6.8%、1.2%、0.9%.女性家庭相关事件发生率高,男性经济相关及其他事件发生率高(P<0.001).调整其他影响因素后,男性经历SLEs与抑郁发作的RRR值(95%CI)为11.99(10.49~13.71),与出现抑郁症状的RRR值(95%CI)为7.43(6.94~7.95);女性经历SLEs与抑郁发作的RRR值(95%CI)为14.15(12.97~15.43),与出现抑郁症状的RRR值(95%CI)为8.30(7.91~8.72).不同性别的SLEs与抑郁症状和抑郁发作的关联差异存在有统计学意义(交互作用P=0.049).在3类SLEs中,家庭相关事件与抑郁的关联在女性中更强(交互作用P<0.001).随着经历10项SLEs个数增多,其与抑郁发作和抑郁症状的RRR值增大.结论 中国成年人负性生活事件与抑郁的关联存在性别差异,其中家庭相关事件对女性的影响更大.经历负性生活事件个数越多,越容易发生抑郁.

abstractsObjective To investigate gender specific differences in the association between stressful life events (SLEs) and depression in Chinese adults aged 30-79 years. Methods In the baseline survey during 2004-2008, the China Kadoorie Biobank (CKB) recruited 512891 men and women aged 30-79 years from 10 areas of China. Detailed information on SLEs, including demographic and socio-economic status, smoking, alcohol drinking and history of chronic disease, as well as depression symptoms and major depressive episodes (MDEs) in preceding 12 months, was collected by using standardized questionnaire. Multinomial logistic regression model was employed to estimate the relative risk ratio (RRR) and 95%CI of SLEs (3 categories, 10 items) on depression and the dose-response relationship between the number of SLEs experienced and depression. The interactions between gender and SLEs on depression were examined with likelihood ratio test. Results Among the 512891 participants, 35085 (6.8%) reported family-related events, 5972 (1.2%) reported finance-related events, and 4453 (0.9%) reported other stressful life events. Females had a higher occurrence of family-related events, while males had a higher occurrence of finance-related and other events (all P-value <0.001). After adjusted for potential confounders, SLEs were significantly associated with MDEs (RRR=11.99, 95%CI: 10.49-13.71 for males; RRR=14.15, 95%CI: 12.97-15.43 for females), and with depressive symptoms (RRR=7.43, 95%CI:6.94-7.95 for males;RRR=8.30, 95%CI: 7.91-8.72 for females). And the associations were stronger in females than in males (P for interaction=0.049). In the three categories of SLEs, family-related events showed stronger association in female (P for interaction<0.001), while no gender specific differences were observed for the other two categories (all P-value>0.05). Furthermore, the effect of the number of SLEs experienced increased in a dose-response manner on depressive symptoms and MDEs for both genders, but no gender specific differences were found. Conclusions The gender modifies the association between stressful life events and depression in Chinese adults, and women experienced family-related events have a greater risk of depression. The more the stressful events experienced, the more likely to have depression.