Center of Research on Psychology in Somatic diseases, Department of Medical Psychology and Neuropsychology, Tilburg University, Tilburg, The Netherlands.
J Vasc Surg. 2010 Sep;52(3):637-44. doi: 10.1016/j.jvs.2010.04.025. Epub 2010 Jun 23.
Gender disparities, particularly among young women with cardiovascular disease, are a growing cause for concern. Depression is a prevalent and prognostically important comorbidity in peripheral arterial disease (PAD), but its prevalence has not been described as a function of gender and age. Therefore, we compared depressive symptoms at the time of PAD diagnosis and 6 months later by gender and age in PAD patients.
The study enrolled 444 newly diagnosed patients with PAD (32% women) from two Dutch vascular outpatient clinics. Patients' depressive symptoms were assessed with the 10-item Center for Epidemiological Studies Depression Scale (CES-D) at baseline and 6 months later (CES-D scores >or=4 indicate significant depressive symptoms). Logistic regression models were constructed to evaluate the relationship among four gender-age groups (women <65 and >or=65 years; men <65 and >or=65 years [reference category]) and baseline and 6-month follow-up depressive symptoms.
Initially, 33% of women <65 years had significant depressive symptoms, and 6 months later, significant depressive symptoms had developed in 19% of the other younger women. These rates were much higher than other gender-age groups (range at baseline, 11%-16%; 6-month incidence, 6%-10%; P <or= .03). Adjusting for demographics and clinical factors, women <65 years experienced a fourfold greater odds of baseline (odds ratio [OR], 4.3; 95% confidence interval [CI], 2.2-8.7) and follow-up depressive symptoms (OR, 4.1; 95% CI, 2.0-8.4) compared with men >or=65 years, whereas other gender-age groups were not at risk. Additional adjustment for change in the ankle-brachial index did not explain the increased depression risk in younger women (OR, 3.5; 95% CI, 1.2-10.2).
Significant depressive symptoms are more common in younger women with PAD than in other gender-age groups, both at the time of diagnosis and 6 months later. To eradicate gender-based disparities in PAD, depression screening and monitoring in younger women may be an important direction for future research and intervention.
心血管疾病患者中性别差异，尤其是年轻女性中的性别差异，日益令人担忧。抑郁症是外周动脉疾病（PAD）中一种普遍且预后重要的合并症，但尚未根据性别和年龄对其患病率进行描述。因此，我们比较了 PAD 患者在诊断时和 6 个月后的抑郁症状，按性别和年龄进行了比较。
这项研究纳入了来自荷兰两家血管门诊的 444 名新诊断的 PAD 患者（32%为女性）。在基线和 6 个月后，使用 10 项流行病学研究中心抑郁量表（CES-D）评估患者的抑郁症状（CES-D 评分>或=4 表示有明显的抑郁症状）。构建了逻辑回归模型，以评估四个性别-年龄组（<65 岁的女性和>或=65 岁的女性；<65 岁的男性和>或=65 岁的男性[参考类别]）与基线和 6 个月随访时抑郁症状之间的关系。
最初，<65 岁的女性中有 33%有明显的抑郁症状，6 个月后，其他年轻女性中有 19%出现了明显的抑郁症状。这些比率远高于其他性别-年龄组（基线时的比率范围为 11%-16%；6 个月时的发病率为 6%-10%；P<或=0.03）。调整人口统计学和临床因素后，与>或=65 岁的男性相比，<65 岁的女性在基线时（比值比[OR]，4.3；95%置信区间[CI]，2.2-8.7）和随访时（OR，4.1；95%CI，2.0-8.4）发生抑郁症状的可能性高四倍，而其他性别-年龄组则没有风险。进一步调整踝臂指数的变化并不能解释年轻女性中抑郁风险的增加（OR，3.5；95%CI，1.2-10.2）。
与其他性别-年龄组相比，PAD 年轻女性在诊断时和 6 个月后均更常见明显的抑郁症状。为了消除 PAD 中的性别差异，对年轻女性进行抑郁筛查和监测可能是未来研究和干预的一个重要方向。
