中年时期的抑郁症状与晚年生活功能受限的发展：抑郁症状的长期影响。
Depressive symptoms in middle age and the development of later-life functional limitations: the long-term effect of depressive symptoms.
机构信息
Department of Medicine, University of California, San Francisco, San Francisco VA Medical Center (181G), 4150 Clement, San Francisco, CA 94121, USA.
出版信息
J Am Geriatr Soc. 2010 Mar;58(3):551-6. doi: 10.1111/j.1532-5415.2010.02723.x. Epub 2010 Feb 16.
OBJECTIVES
To determine whether middle-aged persons with depressive symptoms are at higher risk for developing activity of daily living (ADL) and mobility limitations as they advance into older age than those without.
DESIGN
Prospective cohort study.
SETTING
The Health and Retirement Study (HRS), a nationally representative sample of people aged 50 to 61.
PARTICIPANTS
Seven thousand two hundred seven community living participants in the 1992 wave of the HRS.
MEASUREMENTS
Depressive symptoms were measured using the 11-item Center for Epidemiologic Studies Depression Scale (CES-D 11), with scores of 9 or more (out of 33) classified as significant depressive symptoms. Difficulty with five ADLs and basic mobility tasks (walking several blocks or up one flight of stairs) was measured every 2 years through 2006. The primary outcome was persistent difficulty with ADLs or mobility, defined as difficulty in two consecutive waves.
RESULTS
Eight hundred eighty-seven (12%) subjects scored 9 or higher on the CES-D 11 and were classified as having significant depressive symptoms. Over 12 years of follow-up, subjects with depressive symptoms were more likely to reach the primary outcome measure of persistent difficulty with mobility or difficulty with ADL function (45% vs 23%, Cox hazard ratio (HR)=2.33, 95% confidence interval (CI)=2.06-2.63). After adjusting for age, sex, measures of socioeconomic status, comorbid conditions, high body mass index, smoking, exercise, difficulty jogging 1 mile, and difficulty climbing several flights of stairs, the risk was attenuated but still statistically significant (Cox HR=1.44, 95% CI=1.25-1.66).
CONCLUSION
Depressive symptoms independently predict the development of persistent limitations in ADLs and mobility as middle-aged persons advance into later life. Middle-aged persons with depressive symptoms may be at greater risk for losing their functional independence as they age.
目的
确定中年有抑郁症状的人是否比没有抑郁症状的人在步入老年后更容易出现日常生活活动（ADL）和行动受限。
设计
前瞻性队列研究。
地点
健康与退休研究（HRS），一个 50 至 61 岁人群的全国代表性样本。
参与者
HRS 1992 年波的 7207 名社区生活参与者。
测量
抑郁症状使用 11 项中心流行病学研究抑郁量表（CES-D 11）进行测量，得分 9 或以上（33 分制）为有显著抑郁症状。每 2 年通过 2006 年的两次测量评估五项 ADL 和基本移动任务（步行几个街区或上一段楼梯）的困难程度。主要结果是 ADL 或移动能力持续困难，定义为连续两次困难。
结果
887 名（12%）受试者 CES-D 11 得分 9 或更高，被归类为有显著抑郁症状。在 12 年的随访中，有抑郁症状的受试者更有可能达到持续存在的移动或 ADL 功能困难的主要结果测量（45%比 23%，Cox 风险比（HR）=2.33，95%置信区间（CI）=2.06-2.63）。调整年龄、性别、社会经济地位衡量标准、合并症、高身体质量指数、吸烟、运动、慢跑 1 英里困难、爬几段楼梯困难等因素后，风险仍然显著（Cox HR=1.44，95%CI=1.25-1.66）。
结论
抑郁症状独立预测中年人群进入老年后 ADL 和移动能力持续受限的发展。有抑郁症状的中年人群随着年龄的增长可能更有可能失去其功能独立性。
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