Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France.
J Psychiatr Res. 2013 Jul;47(7):851-7. doi: 10.1016/j.jpsychires.2013.03.015. Epub 2013 Apr 13.
Individuals with severe mental disorders (SMD) have an increased risk of mortality from somatic diseases. This study examined whether this risk is different in persons with depressive disorders compared to those with other SMD (i.e. schizophrenia and bipolar disorder). In 1989, 20,625 employees of the French national gas and electricity company (15,011 men and 5614 women, aged 35-50) agreed to participate in the GAZEL cohort study. Three diagnosis groups were created based on sick leave spells from 1978 onwards: 1) no SMD, 2) depressive disorders and 3) other SMD. Dates and causes of death were available from January 1, 1990 to December 31, 2010. The association of diagnosis groups with mortality was estimated with hazard ratios (HR) and 95% confidence intervals (CI) computed using Cox regression. During a mean follow-up of 19.8 years, 1544 participants died, including 1343 from a natural cause, of which 258 died from cardiovascular diseases. After adjustment for age, gender, occupational status, alcohol consumption, smoking and body-mass index, participants with a history of sickness absence for SMD had a greater risk of natural mortality (HR: 1.24, CI: 1.08-1.43), cardiovascular mortality (HR: 1.49, CI: 1.08-2.05) and non-cardiovascular natural mortality (HR: 1.19, CI: 1.02-1.39). Compared to depressive disorders, other SMD were associated with an increased risk of natural mortality (HR: 1.94, CI: 1.17-3.22) and cardiovascular mortality (HR: 3.58, CI: 1.53-8.39). Job security and systematic medical follow-up may fall short of preventing premature death among workers with sickness absence due to SMD.
患有严重精神障碍(SMD)的个体因躯体疾病导致的死亡率增加。本研究旨在探讨与其他 SMD(即精神分裂症和双相情感障碍)患者相比,患有抑郁症患者的这种风险是否不同。1989 年,法国国有天然气和电力公司的 20625 名员工(15011 名男性和 5614 名女性,年龄 35-50 岁)同意参加 GAZEL 队列研究。根据 1978 年以来的病假情况,创建了三个诊断组:1)无 SMD,2)抑郁症,3)其他 SMD。自 1990 年 1 月 1 日至 2010 年 12 月 31 日,可获得死亡日期和原因。使用 Cox 回归计算风险比(HR)和 95%置信区间(CI)来估计诊断组与死亡率之间的关联。在平均 19.8 年的随访期间,有 1544 名参与者死亡,其中 1343 人死于自然原因,其中 258 人死于心血管疾病。在调整年龄、性别、职业状况、酒精摄入、吸烟和体重指数后,患有 SMD 病史的参与者死于自然原因的风险更高(HR:1.24,CI:1.08-1.43)、心血管疾病死亡率(HR:1.49,CI:1.08-2.05)和非心血管自然死亡率(HR:1.19,CI:1.02-1.39)。与抑郁症相比,其他 SMD 与自然死亡率(HR:1.94,CI:1.17-3.22)和心血管死亡率(HR:3.58,CI:1.53-8.39)增加相关。工作保障和系统的医疗随访可能不足以预防因 SMD 而缺勤的工人过早死亡。