Villamil Elena, Huppert Felicia A, Melzer David
Epidemiology for Policy Group, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
Psychol Med. 2006 Jul;36(7):999-1009. doi: 10.1017/S0033291706007719. Epub 2006 May 2.
Common mental disorder prevalence decreases substantially around the conventional retirement age for men in the UK, but trends for older women are more continuous. Prevalence changes in depression and anxiety around retirement are less clear, as is the role of risk factors. The aim of this study was to establish whether work status, age or other known risk factors account for the reduced prevalence of depressive episode and anxiety disorder around retirement ages for men and for women.
The British Psychiatric Morbidity Survey (BPMS) 2000 was analysed, including 1875 men and 2253 women aged 45-75 years. Diagnoses were from the Revised Clinical Interview Schedule (CIS-R). Logistic models were adjusted for sociodemographic factors, social network, work status, life events, physical illness and disability.
There are marked reductions in the prevalence of depressive episode after 60 years for women [60% lower prevalence, 95% confidence interval (CI) 40-80] and 65 years for men (90% lower prevalence, 95% CI 70-100), compared to the youngest age groups. For anxiety disorder, the reduction in prevalence was 80% (95% CI 60-90) for men and 40% (95% CI 20-60) for women. In fully adjusted multivariate models, the strong association between diagnoses and age groups remained, for both genders. Work status was a significant factor for men but not for women.
There is a discontinuity in the prevalence of depressive episode for both men and women, coinciding with statutory retirement ages. No studied risk factor reduced the associations between age group and disorders. This population scale recovery may provide a model for understanding non-genetic factors.
在英国,常见精神障碍的患病率在男性的传统退休年龄左右大幅下降,但老年女性的患病率趋势更为持续。退休前后抑郁症和焦虑症患病率的变化尚不清楚,风险因素的作用也不明确。本研究的目的是确定工作状态、年龄或其他已知风险因素是否能解释男性和女性在退休年龄前后抑郁发作和焦虑症患病率降低的原因。
对2000年英国精神病发病率调查(BPMS)进行了分析,包括1875名年龄在45 - 75岁之间的男性和2253名女性。诊断依据修订后的临床访谈问卷(CIS - R)。逻辑模型针对社会人口学因素、社交网络、工作状态、生活事件、身体疾病和残疾进行了调整。
与最年轻年龄组相比,60岁及以上女性抑郁发作的患病率显著降低[患病率降低60%,95%置信区间(CI)40 - 80],65岁及以上男性抑郁发作的患病率降低90%(95% CI 70 - 100)。对于焦虑症,男性患病率降低80%(95% CI 60 - 90),女性患病率降低40%(95% CI 20 - 60)。在完全调整的多变量模型中,诊断与年龄组之间的强关联在两性中均依然存在。工作状态对男性是一个显著因素,但对女性不是。
男性和女性抑郁发作的患病率均存在不连续性,与法定退休年龄一致。没有研究过的风险因素能减弱年龄组与疾病之间的关联。这种人群规模的恢复情况可能为理解非遗传因素提供一个模型。