Kroenke Candyce H, Bennett Gary G, Fuchs Charles, Giovannucci Ed, Kawachi Ichiro, Schernhammer Eva, Holmes Michelle D, Kubzansky Laura D
Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA 02115, USA.
Am J Epidemiol. 2005 Nov 1;162(9):839-48. doi: 10.1093/aje/kwi302. Epub 2005 Oct 5.
The authors examined depressive symptoms and prospective incidence of colorectal cancer and distal colorectal adenomas in 81,612 women without prior cancer from the Nurses' Health Study; 400 cases of colorectal cancer and 680 distal colorectal adenomas accrued between 1992 and the year 2000. Depressive symptoms were assessed in 1992 and 1996 with the five-question Mental Health Index (MHI-5), a subscale of the Short-Form 36 health status survey. Scores ranged from 0 to 100, and women with scores between 0 and 52 were defined as having significant depressive symptomatology. The authors also created four categories across the range of Mental Health Index scores: 0-52, 53-75, 76-85, and 86-100 (referent). Cox proportional hazards models were used to analyze the extent of depressive symptoms and colorectal events. Analyses were stratified by body mass index. In multivariate analyses with updated exposure, women with the highest levels of depressive symptoms had an elevated risk of incident colorectal cancer (hazard ratio = 1.43, 95% confidence interval: 0.97, 2.11) compared with women with the lowest levels of symptoms (p(trend) = 0.04). Associations appeared stronger in overweight women. However, depressive symptoms were unrelated to risk of colorectal adenomas. Associations are consistent with a possible role in late promotion of the disease.
作者在护士健康研究中对81612名无癌症病史的女性的抑郁症状以及结直肠癌和远端结直肠腺瘤的发病情况进行了研究；在1992年至2000年间共确诊了400例结直肠癌和680例远端结直肠腺瘤。1992年和1996年使用由36项健康状况调查问卷中的一个子量表——包含5个问题的心理健康指数（MHI-5）对抑郁症状进行评估。得分范围为0至100，得分在0至52之间的女性被定义为有明显的抑郁症状。作者还根据心理健康指数得分范围创建了四个类别：0-52、53-75、76-85和86-100（参照组）。采用Cox比例风险模型分析抑郁症状与结直肠疾病事件之间的关联程度。分析按体重指数进行分层。在对最新暴露情况进行的多变量分析中，与症状水平最低的女性相比，抑郁症状水平最高的女性患结直肠癌的风险升高（风险比=1.43，95%置信区间：0.97，2.11）（趋势p值=0.04）。超重女性中的关联似乎更强。然而，抑郁症状与结直肠腺瘤的风险无关。这些关联与该疾病晚期促进过程中可能发挥的作用一致。
