Population Health and Health Determinants Unit, National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Roma, Italy.
Psychol Med. 2012 Dec;42(12):2619-29. doi: 10.1017/S0033291712000645. Epub 2012 Apr 11.
Depression is recognized as being associated with increased mortality. However, there has been little previous research on the impact of longitudinal changes in late-life depressive symptoms on mortality, and of their remission in particular.
As part of a prospective, population-based study on a random sample of 5632 subjects aged 65-84 years, with a 10-year follow-up of vital status, depressive symptoms were assessed by the 30-item Italian version of the Geriatric Depression Scale (GDS). The number of participants in the GDS measurements was 3214 at baseline and 2070 at the second survey, 3 years later. Longitudinal changes in depressive symptoms (stable, remitted, worsened) were examined in participants in both evaluations (n=1941). Mortality hazard ratios (MHRs) according to severity of symptoms and their changes over time were obtained by means of Cox proportional hazards regression models, adjusting for age and other potentially confounding factors.
Severity is significantly associated with excess mortality in both genders. Compared to the stability of depressive symptoms, a worsened condition shows a higher 7-year mortality risk [MHR 1.46, 95% confidence interval (CI) 1.15-1.84], whereas remission reduces by about 40% the risk of mortality in both genders (women MHR 0.55, 95% CI 0.32-0.95; men MHR 0.59, 95% CI 0.37-0.93). Neither sociodemographic nor medical confounders significantly modified these associations.
Consistent with previous reports, the severity and persistence of depression are associated with higher mortality risks. Our findings extend the magnitude of the association demonstrating that remission of symptoms is related to a significant reduction in mortality, highlighting the need to enhance case-finding and successful treatment of late-life depression.
抑郁症被认为与死亡率升高有关。然而，此前关于晚年抑郁症状的纵向变化对死亡率的影响，特别是其缓解对死亡率的影响的研究较少。
作为一项针对 5632 名 65-84 岁随机样本的前瞻性、基于人群的研究的一部分，对其进行了为期 10 年的生存状态随访，使用 30 项意大利版老年抑郁量表（GDS）评估抑郁症状。在基线时有 3214 名参与者进行了 GDS 测量，3 年后的第二次调查时有 2070 名参与者进行了 GDS 测量。在两次评估中（n=1941），检查了参与者中抑郁症状的纵向变化（稳定、缓解、恶化）。通过 Cox 比例风险回归模型获得了根据症状严重程度和随时间变化的死亡率风险比（MHR），并调整了年龄和其他潜在混杂因素。
严重程度与两性的死亡率增加显著相关。与抑郁症状的稳定性相比，恶化状态显示出更高的 7 年死亡率风险[MHR 1.46，95%置信区间（CI）1.15-1.84]，而缓解在两性中都将死亡率风险降低了约 40%（女性 MHR 0.55，95%CI 0.32-0.95；男性 MHR 0.59，95%CI 0.37-0.93）。社会人口统计学和医学混杂因素均未显著改变这些关联。
与先前的报告一致，抑郁的严重程度和持续存在与更高的死亡率风险相关。我们的发现扩展了关联的程度，表明症状的缓解与死亡率的显著降低相关，突出了增强对晚年抑郁的病例发现和成功治疗的必要性。
