Western Australian Centre for Health & Ageing, Centre for Medical Research of the University of Western Australia, Perth, Australia.
Int Psychogeriatr. 2011 Mar;23(2):280-91. doi: 10.1017/S1041610210001870. Epub 2010 Sep 30.
Many factors have been associated with the onset and maintenance of depressive symptoms in later life, although this knowledge is yet to be translated into significant health gains for the population. This study gathered information about common modifiable and non-modifiable risk factors for depression with the aim of developing a practical probabilistic model of depression that can be used to guide risk reduction strategies.
A cross-sectional study was undertaken of 20,677 community-dwelling Australians aged 60 years or over in contact with their general practitioner during the preceding 12 months. Prevalent depression (minor or major) according to the Patient Health Questionnaire (PHQ-9) assessment was the main outcome of interest. Other measured exposures included self-reported age, gender, education, loss of mother or father before age 15 years, physical or sexual abuse before age 15 years, marital status, financial stress, social support, smoking and alcohol use, physical activity, obesity, diabetes, hypertension, and prevalent cardiovascular diseases, chronic respiratory diseases and cancer.
The mean age of participants was 71.7 ± 7.6 years and 57.9% were women. Depression was present in 1665 (8.0%) of our subjects. Multivariate logistic regression showed depression was independently associated with age older than 75 years, childhood adverse experiences, adverse lifestyle practices (smoking, risk alcohol use, physical inactivity), intermediate health hazards (obesity, diabetes and hypertension), comorbid medical conditions (clinical history of coronary heart disease, stroke, asthma, chronic obstructive pulmonary disease, emphysema or cancers), and social or financial strain. We stratified the exposures to build a matrix that showed that the probability of depression increased progressively with the accumulation of risk factors, from less than 3% for those with no adverse factors to more than 80% for people reporting the maximum number of risk factors.
Our probabilistic matrix can be used to estimate depression risk and to guide the introduction of risk reduction strategies. Future studies should now aim to clarify whether interventions designed to mitigate the impact of risk factors can change the prevalence and incidence of depression in later life.
许多因素与晚年抑郁症状的发生和持续有关，但这些知识尚未转化为人群的显著健康收益。本研究收集了与抑郁相关的常见可改变和不可改变的风险因素信息，旨在开发一种实用的抑郁概率模型，用于指导降低风险的策略。
对 20677 名年龄在 60 岁及以上、在过去 12 个月内与全科医生有过接触的澳大利亚社区居民进行了横断面研究。根据患者健康问卷（PHQ-9）评估，主要结局为现患抑郁（轻度或重度）。其他测量的暴露因素包括自我报告的年龄、性别、教育程度、15 岁前失去母亲或父亲、15 岁前遭受身体或性虐待、婚姻状况、经济压力、社会支持、吸烟和饮酒、身体活动、肥胖、糖尿病、高血压以及现患心血管疾病、慢性呼吸道疾病和癌症。
参与者的平均年龄为 71.7 ± 7.6 岁，57.9%为女性。我们的研究对象中，有 1665 人（8.0%）存在抑郁。多变量逻辑回归显示，年龄大于 75 岁、儿童期不良经历、不良生活方式（吸烟、风险饮酒、身体不活动）、中度健康危害（肥胖、糖尿病和高血压）、合并医疗状况（冠心病、中风、哮喘、慢性阻塞性肺疾病、肺气肿或癌症的临床病史）和社会或经济压力与抑郁独立相关。我们对暴露因素进行分层，构建了一个矩阵，表明随着危险因素的积累，抑郁的概率逐渐增加，从不超过 3%的无不良因素人群到超过 80%的报告最多危险因素的人群。
我们的概率矩阵可用于估计抑郁风险，并指导引入降低风险的策略。未来的研究现在应该旨在阐明旨在减轻风险因素影响的干预措施是否可以改变晚年抑郁的患病率和发病率。
