Newson Rachel S, Hek Karin, Luijendijk Hendrika J, Hofman Albert, Witteman Jacqueline C M, Tiemeier Henning
Department of Epidemiology, Erasmus University Medical Centre, the Netherlands.
Arch Gen Psychiatry. 2010 Nov;67(11):1144-51. doi: 10.1001/archgenpsychiatry.2010.142.
Depression is a prominent concern for older adults; therefore, it is important to identify causal mechanisms so that prevention and treatment strategies can be developed. The vascular depression hypothesis proposes that vascular factors precede the onset of depression in older adults. However, although cross-sectional associations have been established, owing to a lack of objective assessments and longitudinal data, the validity and temporal nature of this relationship is unclear.
To examine whether atherosclerosis, an asymptomatic subclinical indicator of vascular burden, increases the risk of developing depression in older adults.
Prospective, population-based study.
Set within the Rotterdam study, participants were assessed on objective measures of generalized atherosclerosis at baseline (1997-1999) and followed up for an average of 6 years for incident depression.
The baseline sample consisted of 3564 participants (56% female) with a mean age of 72 years who initially did not have depression or dementia.
Depression was categorized into symptoms or syndromes and assessed in a multidimensional manner from physician and mental health specialist reports, pharmacy records (antidepressant usage), a clinical interview, and self-report.
During 21 083 person-years, 429 incidents of depressive symptoms and 197 incidents of depressive syndromes occurred. Individual atherosclerotic measures and a composite measure were not predictive of incident depressive symptoms (composite measure hazard ratio, 0.93; 95% confidence interval, 0.83-1.05) or incident depressive syndromes (composite measure hazard ratio, 0.97; 95% confidence interval, 0.81-1.16). An a priori power analysis indicated a sufficient sample size (α = .05; 0.95 power).
Atherosclerosis does not appear to increase the risk of incident depression in older adults. These findings do not support the vascular depression hypothesis and, alternatively, taking findings from prior studies into account, suggest either that depression contributes to vascular burden or that both result from an underlying biological substrate.
抑郁症是老年人面临的一个突出问题；因此，识别其因果机制以便制定预防和治疗策略非常重要。血管性抑郁假说提出，血管因素先于老年人抑郁症的发作。然而，尽管已经建立了横断面关联，但由于缺乏客观评估和纵向数据，这种关系的有效性和时间性质尚不清楚。
研究动脉粥样硬化（一种血管负担的无症状亚临床指标）是否会增加老年人患抑郁症的风险。
前瞻性、基于人群的研究。
在鹿特丹研究中，参与者在基线时（1997 - 1999年）接受了全身性动脉粥样硬化的客观测量评估，并对新发抑郁症进行了平均6年的随访。
基线样本包括3564名参与者（56%为女性），平均年龄72岁，最初无抑郁症或痴呆症。
抑郁症分为症状或综合征，并通过医生和心理健康专家报告、药房记录（抗抑郁药使用情况）、临床访谈和自我报告进行多维度评估。
在21083人年期间，发生了429例抑郁症状事件和197例抑郁综合征事件。个体动脉粥样硬化测量指标和综合测量指标均不能预测新发抑郁症状（综合测量指标风险比，0.93；95%置信区间，0.83 - 1.05）或新发抑郁综合征（综合测量指标风险比，0.97；95%置信区间，0.81 - 1.16）。一项预先的功效分析表明样本量充足（α = 0.05；功效为0.95）。
动脉粥样硬化似乎不会增加老年人新发抑郁症的风险。这些发现不支持血管性抑郁假说，相反，结合先前研究的结果，表明要么是抑郁症导致血管负担加重，要么两者均由潜在的生物学基质引起。
