Schulz R, Beach S R, Ives D G, Martire L M, Ariyo A A, Kop W J
Department of Psychiatry, The University Center for Social and Urban Research, University of Pittsburgh, PA 15260, USA. schulz+@pitt.edu
Arch Intern Med. 2000 Jun 26;160(12):1761-8. doi: 10.1001/archinte.160.12.1761.
Studies of the association between depressive symptoms and mortality in elderly populations have yielded contradictory findings. To address these discrepancies, we test this association using the most extensive array of sociodemographic and physical health control variables ever studied, to our knowledge, in a large population-based sample of elderly individuals.
To examine the relation between baseline depressive symptoms and 6-year all-cause mortality in older persons, systematically controlling for sociodemographic factors, clinical disease, subclinical disease, and health risk factors.
A total of 5201 men and women aged 65 years and older from 4 US communities participated in the study. Depressive symptoms and 4 categories of covariates were assessed at baseline. The primary outcome measure was 6-year mortality.
Of the 5201 participants, 984 (18.9%) died within 6 years. High baseline depressive symptoms were associated with a higher mortality rate (23.9%) than low baseline depression scores (17.7%) (unadjusted relative risk [RR], 1.41; 95% confidence interval [CI], 1.22-1.63). Depression was also an independent predictor of mortality when controlling for sociodemographic factors (RR, 1.43; 95% CI, 1.23-1.66), prevalent clinical disease (RR, 1.25; 95% CI, 1.07-1.45), subclinical disease indicators (RR, 1.35; 95% CI, 1.15-1.58), or biological or behavioral risk factors (RR, 1.42; 95% CI, 1.22-1.65). When the best predictors from all 4 classes of variables were included as covariates, high depressive symptoms remained an independent predictor of mortality (RR, 1.24; 95% CI, 1.06-1.46).
High levels of depressive symptoms are an independent risk factor for mortality in community-residing older adults. Motivational depletion may be a key underlying mechanism for the depression-mortality effect.
关于老年人群中抑郁症状与死亡率之间关联的研究结果相互矛盾。为解决这些差异，据我们所知，我们在一个基于大量人群的老年个体样本中，使用了有史以来最广泛的社会人口统计学和身体健康控制变量来检验这种关联。
在系统控制社会人口统计学因素、临床疾病、亚临床疾病和健康风险因素的情况下，研究老年人基线抑郁症状与6年全因死亡率之间的关系。
来自美国4个社区的5201名65岁及以上的男性和女性参与了该研究。在基线时评估抑郁症状和4类协变量。主要结局指标是6年死亡率。
在5201名参与者中，984人（18.9%）在6年内死亡。与低基线抑郁评分（17.7%）相比，高基线抑郁症状与更高的死亡率（23.9%）相关（未调整相对风险[RR]，1.41；95%置信区间[CI]，1.22 - 1.63）。在控制社会人口统计学因素（RR，1.43；95% CI，1.23 - 1.66）、常见临床疾病（RR，1.25；95% CI，1.07 - 1.45）、亚临床疾病指标（RR，1.35；95% CI，1.15 - 1.58）或生物或行为风险因素（RR，1.42；95% CI，1.22 - 1.65）时，抑郁也是死亡率的独立预测因素。当将所有4类变量中的最佳预测因素作为协变量纳入时，高抑郁症状仍然是死亡率的独立预测因素（RR，1.24；95% CI，1.06 - 1.46）。
高水平的抑郁症状是社区居住老年人死亡率的独立危险因素。动机耗竭可能是抑郁 - 死亡率效应的关键潜在机制。
