Moussavi Saba, Chatterji Somnath, Verdes Emese, Tandon Ajay, Patel Vikram, Ustun Bedirhan
Department of Measurement and Health Information Systems, World Health Organization, Geneva, Switzerland.
Lancet. 2007 Sep 8;370(9590):851-8. doi: 10.1016/S0140-6736(07)61415-9.
Depression is an important public-health problem, and one of the leading causes of disease burden worldwide. Depression is often comorbid with other chronic diseases and can worsen their associated health outcomes. Few studies have explored the effect of depression, alone or as a comorbidity, on overall health status.
The WHO World Health Survey (WHS) studied adults aged 18 years and older to obtain data for health, health-related outcomes, and their determinants. Prevalence of depression in respondents based on ICD-10 criteria was estimated. Prevalence values for four chronic physical diseases--angina, arthritis, asthma, and diabetes--were also estimated using algorithms derived via a Diagnostic Item Probability Study. Mean health scores were constructed using factor analysis and compared across different disease states and demographic variables. The relation of these disease states to mean health scores was determined through regression modelling.
Observations were available for 245 404 participants from 60 countries in all regions of the world. Overall, 1-year prevalence for ICD-10 depressive episode alone was 3.2% (95% CI 3.0-3.5); for angina 4.5% (4.3-4.8); for arthritis 4.1% (3.8-4.3); for asthma 3.3% (2.9-3.6); and for diabetes 2.0% (1.8-2.2). An average of between 9.3% and 23.0% of participants with one or more chronic physical disease had comorbid depression. This result was significantly higher than the likelihood of having depression in the absence of a chronic physical disease (p<0.0001). After adjustment for socioeconomic factors and health conditions, depression had the largest effect on worsening mean health scores compared with the other chronic conditions. Consistently across countries and different demographic characteristics, respondents with depression comorbid with one or more chronic diseases had the worst health scores of all the disease states.
Depression produces the greatest decrement in health compared with the chronic diseases angina, arthritis, asthma, and diabetes. The comorbid state of depression incrementally worsens health compared with depression alone, with any of the chronic diseases alone, and with any combination of chronic diseases without depression. These results indicate the urgency of addressing depression as a public-health priority to reduce disease burden and disability, and to improve the overall health of populations.
抑郁症是一个重要的公共卫生问题，也是全球疾病负担的主要原因之一。抑郁症常与其他慢性疾病合并存在，并会加重这些疾病相关的健康后果。很少有研究探讨抑郁症单独或作为合并症对整体健康状况的影响。
世界卫生组织世界卫生调查（WHS）对18岁及以上成年人进行研究，以获取有关健康、健康相关结果及其决定因素的数据。根据国际疾病分类第10版（ICD-10）标准估计受访者中抑郁症的患病率。还使用通过诊断项目概率研究得出的算法估计了四种慢性身体疾病——心绞痛、关节炎、哮喘和糖尿病——的患病率。使用因子分析构建平均健康评分，并在不同疾病状态和人口统计学变量之间进行比较。通过回归建模确定这些疾病状态与平均健康评分之间的关系。
来自世界所有地区60个国家的245404名参与者的观察数据可用。总体而言，仅ICD-10抑郁发作的1年患病率为3.2%（95%CI 3.0-3.5）；心绞痛为4.5%（4.3-4.8）；关节炎为4.1%（3.8-4.3）；哮喘为3.3%（2.9-3.6）；糖尿病为2.0%（1.8-2.2）。患有一种或多种慢性身体疾病的参与者中，平均有9.3%至23.0%合并抑郁症。这一结果显著高于无慢性身体疾病时患抑郁症的可能性（p<0.0001）。在对社会经济因素和健康状况进行调整后，与其他慢性疾病相比，抑郁症对平均健康评分恶化的影响最大。在各个国家和不同人口统计学特征中，抑郁症合并一种或多种慢性疾病的受访者在所有疾病状态中的健康评分最差。
与慢性疾病心绞痛、关节炎、哮喘和糖尿病相比，抑郁症对健康的损害最大。与单独的抑郁症、单独的任何一种慢性疾病以及没有抑郁症的任何慢性疾病组合相比，抑郁症合并症会使健康状况进一步恶化。这些结果表明，将抑郁症作为公共卫生优先事项加以解决，以减轻疾病负担和残疾，并改善人群的整体健康状况是紧迫的。
