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Community-level social support infrastructure and adult onset of major depressive disorder in a south Asian postconflict setting

dc.creatorAxinn, Willaim G.es_ES
dc.creatorChoi, Karmel W.es_ES
dc.creatorGhimire, Dirgha J.es_ES
dc.creatorCole, Faithes_ES
dc.creatorHermosilla, Sabrinaes_ES
dc.creatorBenjet, Corinaes_ES
dc.creatorMorgenstern, Melany C.es_ES
dc.creatorLee, Younga H.es_ES
dc.creatorSmoller, Jordan W.es_ES
dc.date2022
dc.date.accessioned2024-08-07T18:18:21Z
dc.date.available2024-08-07T18:18:21Z
dc.date.issued2022
dc.identifierJC02DIEP22es_ES
dc.identifier.issn2168-622X
dc.identifier.urihttp://repositorio.inprf.gob.mx/handle/123456789/8030
dc.identifier.urihttp://doi.org/10.1001/jamapsychiatry.2021.4052
dc.descriptionImportance: Individual-level social support protects against major depressive disorder (MDD) among adults exposed to trauma. Little is known about the consequences of community-level interventions in the general population. Objective: To determine the potential consequences of neighborhood social infrastructure on incident MDD in a high-risk general population. Design, setting, and participants: This longitudinal, multilevel study estimated associations between a neighborhood-level program in a case-control design and subsequent individual outcomes across 10 years (2006-2015) in a cohort of young adults. Exogenously placed social programs simulate natural experiment conditions in a high-poverty population experiencing armed conflict (1998-2006). The western Chitwan valley in Nepal has a general population at high risk of MDD, with neighborhoods exposed to interventions to improve social support. From a random sample (response rate 93%) selected to represent the general population in 2016, participants aged 25 to 34 years in 2006 were studied. These individuals resided within 149 neighborhoods that varied in their availability of active social support programs. The analyses were conducted between October 2020 and November 2021. Exposures: The Small Farmers Development Program (SFDP) uses shared, joint liability financial credit among neighbors to build social capital and cohesion within neighborhoods. Main outcomes and measures: Onset of DSM-IV MDD after the conflict, assessed by the Nepal-specific, clinically validated World Mental Health Composite International Diagnostic Interview with a life history calendar. The hypothesis tested was that exposure to SFDP reduced adult onset of MDD. Results: Of the 1917 survey participants, 886 (46.2%) were women, and 856 (44.7%) were of Brahmin or Chhetri ethnicity. Of the 149 neighborhoods, 21 had an active SFDP group, and 156 of 1917 (8.1%) participants experienced MDD between 2006 and 2015. Discrete-time hazard models showed participants living in neighborhoods with an SFDP experienced incident MDD at nearly half the rate as others (odds ratio = 0.55; 95% CI, 0.30-1.02; P = .06). A multivariate, multilevel matching analysis showed the incidence of MDD among adults living in neighborhoods with an SFDP was 19 of 256 (7.4%), compared with 33 of 256 (12.9%) in the matched sample with no SFDP (z = 2.05; P = .04). Conclusions and relevance: Living in a neighborhood with community-level social support infrastructure was associated with reduced subsequent rates of adult-onset MDD, even in this high-risk population. Investments in such infrastructure may reduce population-level MDD, supporting clinical focus on potentially unpreventable cases.es_ES
dc.formatPDFes_ES
dc.language.isoenges_ES
dc.publisherAmerican Medical Associationes_ES
dc.relation79(3):243-249
dc.rightsAcceso Cerradoes_ES
dc.titleCommunity-level social support infrastructure and adult onset of major depressive disorder in a south Asian postconflict settinges_ES
dc.typeArtículoes_ES
dc.contributor.affiliationPopulation Studies Center, Institute for Social Research, University of Michigan, Ann Arbor.
dc.contributor.emailbaxinn@umich.edu (William G.Axinn)
dc.relation.jnabreviadoJAMA PSYCHIATRY
dc.relation.journalJAMA Psychiatry
dc.identifier.placeEstados Unidos
dc.date.published2022
dc.identifier.organizacionInstituto Nacional de Psiquiatría Ramón de la Fuente Muñiz
dc.identifier.eissn2168-6238
dc.identifier.doi10.1001/jamapsychiatry.2021.4052


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