Interdisciplinary Center for Psychiatric Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
J Affect Disord. 2010 Jul;124(1-2):38-44. doi: 10.1016/j.jad.2009.10.026. Epub 2009 Nov 24.
The link between physical conditions and mental health is poorly understood. Functional disability could explain the association of physical conditions with major depressive episode (MDE) as an intermediary factor.
Data was analyzed from a subsample (N=8796) of the European Study of the Epidemiology of Mental Disorders (ESEMeD), a cross-sectional general population survey. MDE during the last 12 months was assessed using a revision of the Composite International Diagnostic Interview (CIDI 3.0). Lifetime chronic physical conditions were assessed by self-report. Functional disability was measured using a version of the World Health Organization Disability Assessment Schedule (WHODAS). The associations of physical conditions with MDE and explanation by functional disability were quantified using logistic regression.
All physical conditions were significantly associated with MDE. The increases in risk of MDE ranged from 30% for allergy to amply 100% for arthritis and heart disease. When adjusted for physical comorbidity, associations decreased and were no longer statistically significant for allergy and diabetes. Functional disability explained between 17 and 64% of these associations, most substantially for stomach or duodenum ulcer, arthritis and heart disease.
Due to the cross-sectional nature of the study the temporal relationship of the variables could not be assessed and the amount of explanation cannot simply be interpreted as the amount of mediation.
Our findings suggest that the association of chronic physical conditions with MDE is partly explained by functional disability. Such explanation is more pronounced for pain causing conditions and heart disease. Health professionals should be particularly aware of the increased risk of depressive disorder when patients experience disability from these conditions.
身体状况和心理健康之间的联系尚未被充分理解。功能障碍可能可以解释身体状况与重度抑郁发作（MDE）之间的关联，其作为一个中介因素。
本研究对欧洲精神疾病流行病学研究（ESEMeD）的一个亚样本（N=8796）进行了数据分析，该研究是一项横断面的一般人群调查。使用复合国际诊断访谈（CIDI 3.0）的修订版评估过去 12 个月内的 MDE。通过自我报告评估终生慢性身体状况。使用世界卫生组织残疾评估时间表（WHODAS）的一个版本来测量功能障碍。使用逻辑回归来量化身体状况与 MDE 的关联以及功能障碍的解释程度。
所有身体状况均与 MDE 显著相关。MDE 的风险增加幅度从过敏的 30%到关节炎和心脏病的 100%不等。在调整身体合并症后，过敏和糖尿病的关联减弱且不再具有统计学意义。功能障碍解释了这些关联的 17%至 64%，对于胃或十二指肠溃疡、关节炎和心脏病来说解释程度最大。
由于研究的横断面性质，无法评估变量的时间关系，并且无法简单地将解释程度解释为中介的程度。
我们的研究结果表明，慢性身体状况与 MDE 之间的关联部分是由功能障碍解释的。对于引起疼痛的疾病和心脏病，这种解释更为明显。当患者因这些疾病而出现功能障碍时，健康专业人员应特别注意抑郁障碍的风险增加。
