Nuyen Jasper, Spreeuwenberg Peter M, Beekman Aartjan T F, Groenewegen Peter P, van den Bos Geertrudis A M, Schellevis François G
NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.
J Affect Disord. 2007 Apr;99(1-3):73-81. doi: 10.1016/j.jad.2006.08.011. Epub 2006 Sep 26.
This general practice-based case-control study tested the association between cerebrovascular risk factors (CVRFs) and the development of later-life depression by focusing on the impact of exposure duration to CVRFs and the modifying influence of age at depression onset.
Cases were 286 patients aged > or = 50 years with a first diagnosis of depression at age > or = 50 years. Nondepressed controls (N=832) were individually matched for age, gender and practice. CVRF diagnoses (hypertension, diabetes mellitus, cardiovascular conditions) prior to depression were determined. Analyses controlled for education, somatic and nondepressive psychiatric disease.
No CVRF variable examined was significantly associated with subsequent depression in the total sample. An unexpected impact of age at onset of depression was observed: the odds ratio associated with having any CVRF was smaller for patients with age at onset > or = 70 years than for patients with onset between ages 50-59 years (p=.002) and 60-69 years (p=.067). Subsequent analyses excluding patients with onset at age > or = 70 years revealed that CVRF variables, including long-term exposure to CVRFs, significantly increased the odds of subsequent depression with onset between ages 50 and 69 years.
Reliance on GPs' records of morbidity may have resulted in bias towards underestimation in patients with depression onset at age > or = 70 years.
Our findings suggest that CVRFs play a relevant role in the development of depression with onset between ages 50 and 69 years, but no evidence was found that they contribute to the occurrence of depression with onset at age > or = 70 years. Replication is warranted to exclude the possibility of bias.
这项基于全科医疗的病例对照研究，通过关注脑血管危险因素（CVRFs）的暴露持续时间的影响以及抑郁症发病年龄的调节作用，来检验CVRFs与晚年抑郁症发生之间的关联。
病例为286例年龄≥50岁且首次诊断为抑郁症时年龄≥50岁的患者。非抑郁对照组（N = 832）按年龄、性别和医疗机构进行个体匹配。确定抑郁症发病前的CVRF诊断（高血压、糖尿病、心血管疾病）。分析对教育程度、躯体疾病和非抑郁性精神疾病进行了控制。
在总样本中，所检查的任何CVRF变量均与随后的抑郁症无显著关联。观察到抑郁症发病年龄有意外影响：发病年龄≥70岁的患者与有任何CVRF相关的优势比，低于发病年龄在50 - 59岁（p = 0.002）和60 - 69岁（p = 0.067）的患者。随后排除发病年龄≥70岁患者的分析显示，CVRF变量，包括长期暴露于CVRFs，显著增加了发病年龄在50至69岁之间随后患抑郁症的几率。
依赖全科医生的发病记录可能导致对发病年龄≥70岁的抑郁症患者估计不足的偏差。
我们的研究结果表明，CVRFs在发病年龄在50至69岁之间的抑郁症发生中起相关作用，但未发现它们导致发病年龄≥70岁的抑郁症发生的证据。有必要进行重复研究以排除偏差的可能性。
