Prochaska Judith J, Sorensen James L, Hall Sharon M, Rossi Joseph S, Redding Colleen A, Rosen Amy B, Eisendrath Stuart J, Meisner Marc R
Department of Psychiatry, University of California, San Francisco, CA 94143-0984, USA.
Drug Alcohol Depend. 2005 May 9;78(2):169-75. doi: 10.1016/j.drugalcdep.2004.10.012. Epub 2004 Dec 24.
The relative and combined health effects of cigarette smoking, heroin use, and depression were examined in 322 clinically depressed smokers and 117 opioid-dependent smokers participating in two studies of the San Francisco Treatment Research Center. Opioid-dependent smokers averaged 16 years (S.D.=9) of heroin use; 3% of depressed smokers used opiates in the past 6 months. Cigarettes per day (M=15, S.D.=10) and Beck Depression (BDI-II) scores (M=21, S.D.=11) were comparable between the two groups. Health functioning was assessed using the Medical Outcomes Study Short Form (SF-36). Adjusting for demographic differences, depressed smokers reported better physical but poorer emotional health relative to opioid-dependent smokers. Both groups scored significantly lower than published norms (p<.05). Within groups, severity of depressive symptoms, tobacco use, and opiate use were independent predictors of lower health functioning (p<.05). Examining risk-related subgroups based on depression scores (BDI-II> or =20), cigarettes per day (> or =1 pack), and opiate use, number of risk factors was monotonically related to health functioning in both samples. Individuals with two or more risk factors scored the lowest (p<.05). Severity of depressive symptoms, tobacco use, and opiate use contributed individually and collectively to lower health functioning. Blended treatments that target multiple risk factors are needed to improve health outcomes.
在旧金山治疗研究中心的两项研究中，对322名临床诊断为抑郁症的吸烟者和117名阿片类药物依赖的吸烟者，研究了吸烟、使用海洛因和抑郁症的相对及综合健康影响。阿片类药物依赖的吸烟者平均有16年（标准差 = 9）的海洛因使用史；3%的抑郁症吸烟者在过去6个月内使用过阿片类药物。两组之间每日吸烟量（均值 = 15，标准差 = 10）和贝克抑郁量表（BDI-II）得分（均值 = 21，标准差 = 11）相当。使用医学结局研究简表（SF-36）评估健康功能。在调整人口统计学差异后，与阿片类药物依赖的吸烟者相比，抑郁症吸烟者报告的身体状况较好，但情绪健康较差。两组得分均显著低于已公布的标准（p < 0.05）。在组内，抑郁症状的严重程度、烟草使用和阿片类药物使用是健康功能较低的独立预测因素（p < 0.05）。根据抑郁得分（BDI-II≥20）、每日吸烟量（≥1包）和阿片类药物使用情况检查与风险相关的亚组，在两个样本中，风险因素的数量与健康功能呈单调相关。有两个或更多风险因素的个体得分最低（p < 0.05）。抑郁症状的严重程度、烟草使用和阿片类药物使用分别和共同导致了较低的健康功能。需要针对多种风险因素的综合治疗来改善健康结局。
