女性抑郁症与2型糖尿病之间的双向关联。
Bidirectional association between depression and type 2 diabetes mellitus in women.
作者信息
Pan An, Lucas Michel, Sun Qi, van Dam Rob M, Franco Oscar H, Manson JoAnn E, Willett Walter C, Ascherio Alberto, Hu Frank B
机构信息
Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA.
出版信息
Arch Intern Med. 2010 Nov 22;170(21):1884-91. doi: 10.1001/archinternmed.2010.356.
BACKGROUND
Although it has been hypothesized that the diabetes-depression relation is bidirectional, few studies have addressed this hypothesis in a prospective setting.
METHODS
A total of 65 381 women aged 50 to 75 years in 1996 were observed until 2006. Clinical depression was defined as having diagnosed depression or using antidepressants, and depressed mood was defined as having clinical depression or severe depressive symptoms, ie, a 5-item Mental Health Index (MHI-5) score of 52 or less. Self-reported type 2 diabetes mellitus was confirmed by means of a supplementary questionnaire validated by medical record review.
RESULTS
During 10 years of follow-up (531 097 person-years), 2844 incident cases of type 2 diabetes mellitus were documented. Compared with referents (MHI-5 score of 86-100) who had the best depressive symptom scores, participants with increased severity of symptoms (MHI-5 scores of 76-85 or 53-75, or depressed mood) showed a monotonic elevated risk of developing type 2 diabetes (P for trend = .002 in the multivariable-adjusted model). The relative risk for individuals with depressed mood was 1.17 (95% confidence interval [CI], 1.05-1.30) after adjustment for various covariates, and participants using antidepressants were at a particularly higher relative risk (1.25; 95% CI, 1.10-1.41). In a parallel analysis, 7415 cases of incident clinical depression were documented (474 722 person-years). Compared with nondiabetic subjects, those with diabetes had a relative risk (95% CI) of developing clinical depression after controlling for all covariates of 1.29 (1.18-1.40), and it was 1.25 (1.09-1.42), 1.24 (1.09-1.41), and 1.53 (1.26-1.85) in diabetic subjects without medications, with oral hypoglycemic agents, and with insulin therapy, respectively. These associations remained significant after adjustment for diabetes-related comorbidities.
CONCLUSION
Our results provide compelling evidence that the diabetes-depression association is bidirectional.
背景
尽管已有假说认为糖尿病与抑郁症之间的关系是双向的，但很少有研究在前瞻性研究中探讨这一假说。
方法
对1996年65381名年龄在50至75岁的女性进行观察，直至2006年。临床抑郁症定义为被诊断患有抑郁症或使用抗抑郁药，抑郁情绪定义为患有临床抑郁症或严重抑郁症状，即5项心理健康指数（MHI-5）得分小于或等于52。通过经病历审查验证的补充问卷来确认自我报告的2型糖尿病。
结果
在10年的随访期（531097人年）内，记录了2844例2型糖尿病发病病例。与抑郁症状得分最佳的对照者（MHI-5得分为86 - 100）相比，症状严重程度增加的参与者（MHI-5得分为76 - 85或53 - 75，或有抑郁情绪）患2型糖尿病的风险呈单调升高（多变量调整模型中趋势P值 = 0.002）。在对各种协变量进行调整后，有抑郁情绪个体的相对风险为1.17（95%置信区间[CI]，1.05 - 1.30），使用抗抑郁药的参与者相对风险尤其更高（1.25；95%CI，1.10 - 1.41）。在一项平行分析中，记录了7415例临床抑郁症发病病例（474722人年）。与非糖尿病受试者相比，糖尿病患者在控制所有协变量后患临床抑郁症的相对风险（95%CI）为1.29（1.18 - 1.40），在未用药的糖尿病患者、使用口服降糖药的糖尿病患者和接受胰岛素治疗的糖尿病患者中分别为1.25（1.09 - 1.42）、1.24（1.09 - 1.41）和1.53（1.26 - 1.85）。在对糖尿病相关合并症进行调整后，这些关联仍然显著。
结论
我们的结果提供了令人信服的证据，证明糖尿病与抑郁症之间的关联是双向的。
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