10. doan vuong diem khanh
TRANSCRIPT
Vuong Diem Khanh DoanMichael Dunne Vo Van Thang Gavin Turrell
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The Association between Socioeconomic status &
Depressionin Vietnamese Adults:
pilot study
The Association between Socioeconomic status &
Depressionin Vietnamese Adults:
pilot study
INTRODUCTION
• A consistent pattern of an inverse relationship socioeconomic status (SES)-depressive symptoms.
• The mechanism not well understood. • A significant barrier• Most research from developed
countries. • In Vietnam, serious dearth of research
on depression & no investigation of SES and depression
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“a common mental disorder that presents with depressed mood, loss of interest or pleasure, feelings of guilt or
low self-worth, disturbed sleep or appetite, low energy, and
poor concentration” (WHO)
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Low SES Negative
emotion and
cognition
DepressionAnxiety
hopelessness
Intermediate paths
- Behavioral factors:
Negative health
practices- Biological pathway
SAMa, HPAb, immune function, metabolic
factors
Intermediate paths
- Behavioral factors:
Negative health
practices- Biological pathway
SAMa, HPAb, immune function, metabolic
factors
Health outcome
MortalityMorbidityQuality of
lifeLife
expectancy
Reserve capacity
- Stressful life events- Social support- Psychological resources
Reserve capacity
- Stressful life events- Social support- Psychological resources
(a)SAM: Sympathetic adrenal - medullary system (b) HPA: Hypothalamic- pituitary-adrenocortical axis
1. What is the prevalence of depression among Vietnamese adults?
2. Is the socioeconomic-depression gradient in Vietnam similar to, or different from other cultures?
3. Among Vietnamese adults, what factors mediate the relationship between SES and depression?
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lowSES
-Education- Income- Occupation- Employment
lowSES
-Education- Income- Occupation- Employment
moreDEPRESSIO
N
moreDEPRESSIO
Nmore Stress
-Lifetime trauma -Chronic stress -Recent life events
more Stress
-Lifetime trauma -Chronic stress -Recent life events
lowerSocial support
lowerSocial support
lowerPsychological
resources- Mastery- Self esteem
lowerPsychological
resources- Mastery- Self esteem
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Phase 2
Part 1Exploratory qualitative research
Part 1Exploratory qualitative research
Part 2Pilot
quantitative research
Part 2Pilot
quantitative research
Main survey Main survey
- 2 in-depth interviews
psychiatrist experts- 10 in-depth
interviews with residents
100 Structured interviews
with residents
Structured interview
• Hue city- Central Vietnam - Population : 350,000- 27 quarters
(15 -25 units / each quarter)
• Phu hoi quarter:- Population: 10,121
- Total unit: 16
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Phu hoi
• Section 1: Demographics & SES • Section 2: Self-esteem : Rosenberg self esteem
scale (RSES)• Section 3: Mastery• Section 4: Social support: Multidimensional
Scale of Perceived Social Support (MSPSS)
• Section 5: Depressive symptoms: Centre for Epidemiological Studies-Depression scale (CES-D)
• Section 6: Stress(Lifetime trauma, chronic stress, recent life events)
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• Randomly selected 5 units / 16 units• From the booklet of each units : - Selected every 5 th households
- Each household: Aged 25-55- 20 households /each booklet- 100 participants/ 104 household
approached (response rate 96%)
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• Descriptive statistics • Bivariate data analysis:
- Chi-square - t-tests, ANOVA
- Simple linear regression • Multivariable data analysis
- OLS regression & 3 steps in Barron & Kenny ‘s Framework
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6.2 6.9
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37.5
Education
Above high school (n=32)
High school ( n= 29)
Secondary school (n=23)
Primary or no school (n=16)
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PREVALENCE OF DEPRESSIVE SYMPTOMS (%)
Figure 1: Prevalence of depressive symptoms ( CES-D > 21) by Education level
4.5
9.77.7
33.3
Income
Highest (n= 22)
Middle high (n=31)
Middle low (n=26)
Lowest (n=21)
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Figure 2: Prevalence of depressive symptoms ( CES-D >21) by Income ( quartile groups)
< 16,000VND (< 1.2 AUD per day)
16,000 - < 26,000 VND (1.2 - < 2.0 AUD per day)
26,000-46,000 VND (2.0 - 3.4 AUD per day)
> 46,000 VND (> 3.4 AUD per day)
5.4
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Occupation
High (n=37)
Medium (n=5)
Low stable (n= 27)
Low unstable (n= 15)
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Figure 3: Prevalence of depressive symptoms ( CES-D >21) by Occupation
casual manual non-specialized workers non-manual workers, no professional qualifications
employed manual non-specialized workers non-manual professional or business people with prestigious post.
1. Very strong social gradient wrt depressive symptoms
• Higher education levels report fewer depressive symptoms
• Only individuals at the bottom of the quartile income were strongly associated with higher depressive symptoms compared with the highest income group)
• U shape in relationship between occupation & depressive symptoms (??)
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2. Mediating effects • Lifetime trauma did not have mediating
effects on SES- depression • Self esteem & mastery have very strong
mediating effects on SES – depression • Recent life events have mediating effects on
3 indicators of SES –depression ( education, income, employment)
• Chronic stress has mediating effects on 2 indicators of SES –depression ( education, income)
• Social support has mediating effects on 1 indicators of SES –depression ( occupation)
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1. Mental health care program in Vietnam:
• New evidence regarding the burden of mental distress in Vietnam.
• Practical relevance for advocacy for mental health promotion and health care services.
2. International scientific literature on the social determinants of depression.
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Thank you!
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