Wouts Lonneke, Oude Voshaar Richard C, Bremmer Marijke A, Buitelaar Jan K, Penninx Brenda W J H, Beekman Aartjan T F
Department of Psychiatry, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Arch Gen Psychiatry. 2008 May;65(5):596-602. doi: 10.1001/archpsyc.65.5.596.
Previous research suggests that depression is a risk factor for stroke. However, the reliability of much research is limited by the lack of documentation on the presence of preexistent cardiovascular disease and by the use of limited measures of depression or stroke.
To test the hypotheses that (1) clinically relevant depressive symptoms are an independent risk factor of incident stroke in cardiac and noncardiac patients and (2) more chronic and severe depressive symptoms are associated with incident stroke.
A cohort of elderly Dutch people (aged > or = 55 years) was followed up for 9 years in the Longitudinal Aging Study Amsterdam (baseline measurements were taken in 1992 or 1993, and the study concluded in 2001 or 2002, respectively).
General community.
Randomly selected population-based sample (N = 2965) without a history of stroke.
The study end point was a first stroke (nonfatal or fatal). Depression was measured using the National Institute of Mental Health Diagnostic Interview Schedule and the Center for Epidemiological Studies-Depression Scale. Multivariate Cox proportional hazards regression analyses of stroke incidence were performed. The association of the chronicity and severity of depressive symptoms was studied in extended models with time-dependent variables.
The sample's mean (SD) age was 70.5 (8.7) years, 52.1% were women, and the mean (SD) follow-up was 7.7 (3.1) years. Inclusion of an interaction between cardiac disease and clinically relevant depressive symptoms improved the model for stroke (P = .03). In participants with preexistent cardiac disease, but not in participants without cardiac disease, clinically relevant depressive symptoms at baseline (hazard ratio [HR], 2.18; 95% confidence interval [CI], 1.17-4.09) and the severity (range, 0-60; HR, 1.08; 95% CI, 1.02-1.13) and chronicity (HR, 3.51; 95% CI, 1.13-10.93) of symptoms during follow-up were associated with stroke.
Preexistent cardiac disease moderates the association between depressive symptoms and incident stroke. In cardiac patients, baseline depressive symptoms and both the severity and chronicity of symptoms during follow-up are associated with incident stroke.
先前的研究表明，抑郁症是中风的一个风险因素。然而，许多研究的可靠性受到以下因素的限制：缺乏关于既往心血管疾病存在情况的记录，以及使用的抑郁症或中风测量方法有限。
检验以下假设：（1）临床相关的抑郁症状是心脏和非心脏患者发生中风的独立风险因素；（2）更慢性和严重的抑郁症状与中风发生相关。
在阿姆斯特丹纵向衰老研究中，对一组荷兰老年人（年龄≥55岁）进行了9年的随访（基线测量于1992年或1993年进行，研究分别于2001年或2002年结束）。
普通社区。
基于人群的随机抽样样本（N = 2965），无中风病史。
研究终点为首次中风（非致命或致命）。使用美国国立精神卫生研究所诊断访谈表和流行病学研究中心抑郁量表测量抑郁症。对中风发病率进行多变量Cox比例风险回归分析。在具有时间依赖性变量的扩展模型中研究抑郁症状的慢性和严重程度的关联。
样本的平均（标准差）年龄为70.5（8.7）岁，52.1%为女性，平均（标准差）随访时间为7.7（3.1）年。纳入心脏病与临床相关抑郁症状之间的相互作用改善了中风模型（P = 0.03）。在有既往心脏病的参与者中，但在无心脏病的参与者中未发现，基线时临床相关的抑郁症状（风险比[HR]，2.18；95%置信区间[CI]，1.17 - 4.09）以及随访期间症状的严重程度（范围，0 - 60；HR，1.08；95%CI，1.02 - 1.13）和慢性程度（HR，3.51；95%CI，1.13 - 10.93）与中风相关。
既往心脏病会缓和抑郁症状与中风发生之间的关联。在心脏病患者中，基线抑郁症状以及随访期间症状的严重程度和慢性程度均与中风发生相关。
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