Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, VIC, Australia. Adrienne.o'
Qual Life Res. 2013 Feb;22(1):37-44. doi: 10.1007/s11136-012-0128-4. Epub 2012 Feb 10.
Health-related quality of life (HRQOL) can be significantly impaired by the presence of chronic conditions such as cardiovascular disease (CVD) and major depressive disorder (MDD). The aim of this paper was to (1) identify differences in HRQOL between individuals with CVD, MDD, or both, compared to a healthy reference group, (2) establish whether the influence of co-morbid MDD and CVD on HRQOL is additive or synergistic and (3) determine the way in which depression severity interacts with CVD to influence overall HRQOL.
Population-based data from the 2007 Australian National Survey of Mental Health and Well-being (NSMHWB) (n = 8841) were used to compare HRQOL of individuals with MDD and CVD, MDD but not CVD, CVD but not MDD, with a healthy reference group. HRQOL was measured using the Assessment of Quality of Life (AQOL). MDD was identified using the Composite International Diagnostic Interview (CIDI 3.0).
Of all four groups, individuals with co-morbid CVD and depression reported the greatest deficits in AQOL utility scores (Coef: -0.32, 95% CI: -0.40, -0.23), after adjusting for covariates. Those with MDD only (Coef: -0.27, 95% CI: -0.30, -0.24) and CVD only (Coef: -0.08, 95% CI: -0.11, -0.05) also reported reduced AQOL utility scores. Second, the influence of MDD and CVD on HRQOL was shown to be additive, rather than synergistic. Third, a significant dose-response relationship was observed between depression severity and HRQOL. However, CVD and depression severity appeared to act independently of each other in impacting HRQOL.
HRQOL is greatly impaired in individuals with co-morbid MDD and CVD; these conditions appear to influence HRQOL in an additive fashion. HRQOL alters with depression severity, therefore treating depression and improving HRQOL is of clinical importance.
心血管疾病（CVD）和重度抑郁症（MDD）等慢性疾病会显著影响健康相关生活质量（HRQOL）。本文的目的是：（1）与健康对照组相比，确定 CVD、MDD 或两者并存的个体之间 HRQOL 的差异；（2）确定共患 MDD 和 CVD 对 HRQOL 的影响是相加还是协同的；（3）确定抑郁严重程度与 CVD 相互作用影响整体 HRQOL 的方式。
使用 2007 年澳大利亚国家心理健康和幸福感调查（NSMHWB）（n=8841）的人群数据，比较 MDD 和 CVD、仅有 MDD 而无 CVD、仅有 CVD 而无 MDD 的个体与健康对照组的 HRQOL。HRQOL 使用生活质量评估（AQOL）进行测量。MDD 使用复合国际诊断访谈（CIDI 3.0）进行识别。
在所有四组中，共患 CVD 和抑郁的个体 AQOL 效用评分的下降幅度最大（系数：-0.32，95%CI：-0.40，-0.23），在调整了协变量后。仅有 MDD 的个体（系数：-0.27，95%CI：-0.30，-0.24）和仅有 CVD 的个体（系数：-0.08，95%CI：-0.11，-0.05）报告的 AQOL 效用评分也有所降低。其次，MDD 和 CVD 对 HRQOL 的影响呈相加而非协同作用。第三，观察到抑郁严重程度与 HRQOL 之间存在显著的剂量-反应关系。然而，CVD 和抑郁严重程度似乎在影响 HRQOL 方面相互独立。
共患 MDD 和 CVD 的个体的 HRQOL 严重受损；这些疾病似乎以相加的方式影响 HRQOL。HRQOL 随抑郁严重程度而改变，因此治疗抑郁和改善 HRQOL 具有临床重要性。
