McCusker Jane, Cole Martin, Ciampi Antonio, Latimer Eric, Windholz Sylvia, Belzile Eric
Department of Clinical Epidemiology and Community Studies, St. Mary's Hospital, 3830 Lacombe, Montreal (Quebec), Canada.
J Gerontol A Biol Sci Med Sci. 2006 Sep;61(9):975-81. doi: 10.1093/gerona/61.9.975.
Previous studies of the effect of depression on mortality among older medical inpatients have yielded inconsistent results. We examined the effects on mortality of both a diagnosis of depression at hospital admission and a history of previous depression, taking into account potential sources of bias (sample selection and confounding).
Medical inpatients aged 65+ with at most mild cognitive impairment were recruited at two Montreal hospitals and were screened for depression. All those with a diagnosis of major or minor depression (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM-IV] criteria) and a random sample of nondepressed patients were invited to participate. Baseline data included: history of previous depression, severity of physical illness, comorbidity, and health services utilization. Cox proportional hazards methods were used to analyze survival during the 16- to 52-month follow-up period.
Five hundred patients were enrolled; 116 (23.2%) had a history of previous depression. After adjustment for demographic factors, physical illness, cognitive impairment, and prior service utilization, the only depression group with significantly different mortality was patients with both current major depression and a history of depression, who had lower mortality than all other patient groups (hazard ratio 0.42; 95% confidence interval: 0.25, 0.70).
Among patients with no history of depression, a diagnosis of depression was not associated with mortality after adjustment for confounding by physical illness and other factors. Coincident major depression and history of depression was associated with decreased mortality.
先前关于老年内科住院患者中抑郁症对死亡率影响的研究结果并不一致。我们在考虑潜在偏倚来源(样本选择和混杂因素)的情况下,研究了入院时抑郁症诊断及既往抑郁症病史对死亡率的影响。
在蒙特利尔的两家医院招募了年龄在65岁及以上、至多有轻度认知障碍的内科住院患者,并对其进行抑郁症筛查。所有被诊断为重度或轻度抑郁症(符合《精神障碍诊断与统计手册》第四版[DSM-IV]标准)的患者以及非抑郁症患者的随机样本均受邀参与。基线数据包括:既往抑郁症病史、身体疾病严重程度、合并症以及卫生服务利用情况。采用Cox比例风险法分析16至52个月随访期内的生存率。
共纳入500名患者;116名(23.2%)有既往抑郁症病史。在对人口统计学因素、身体疾病、认知障碍和既往服务利用情况进行调整后,唯一死亡率有显著差异的抑郁症组是当前患有重度抑郁症且有抑郁症病史的患者,其死亡率低于所有其他患者组(风险比0.42;95%置信区间:0.25,0.70)。
在无抑郁症病史的患者中,经身体疾病和其他因素混杂调整后,抑郁症诊断与死亡率无关。同时患有重度抑郁症和抑郁症病史与死亡率降低相关。