Department of Medical Humanities and Social Sciences, Florida State University College of Medicine, Tallahassee 32306, USA.
JAMA Psychiatry. 2013 Aug;70(8):803-11. doi: 10.1001/jamapsychiatry.2013.193.
Long-term longitudinal studies are needed to delineate the trajectory of depressive symptoms across adulthood and to individuate factors that may contribute to increases in depressive symptoms in older adulthood.
To estimate the trajectory of depressive symptoms across the adult life span; to test whether this trajectory varies by demographic factors (sex, ethnicity, and educational level) and antidepressant medication use; and to test whether disease burden, functional limitations, and proximity to death explain the increase in depressive symptoms in old age.
Longitudinal study.
Community.
The study included 2320 participants (47.0% female; mean [SD] age at baseline, 58.1 [17.0] years; range, 19-95 years) from the Baltimore Longitudinal Study of Aging.
Estimated trajectory of depressive symptoms modeled from 10, 982 assessments (mean [SD] assessments per participant, 4.7 [3.6]; range, 1-21) based on the Center for Epidemiologic Studies Depression scale and 3 subscales (depressed affect, somatic complaints, and interpersonal problems).
The linear (γ10 = 0.52; P < .01) and quadratic (γ20 = 0.43; P < .01) terms were significant, which indicated that depressive symptoms were highest in young adulthood, decreased across middle adulthood, and increased again in older adulthood. The subscales followed a similar pattern. Women reported more depressed affect at younger ages, but an interaction with age suggested that this gap disappeared in old age. Accounting for comorbidity, functional limitations, and impending death slightly reduced but did not eliminate the uptick in depressive symptoms in old age.
Symptoms of depression follow a U-shaped pattern across adulthood. Older adults experience an increase in distress that is not due solely to declines in physical health or approaching death.
需要进行长期纵向研究，以描绘成年期抑郁症状的轨迹，并确定可能导致老年期抑郁症状增加的因素。
估计成年期抑郁症状的轨迹；测试该轨迹是否因人口统计学因素（性别、种族和教育水平）和抗抑郁药物使用而有所不同；并测试疾病负担、功能限制和接近死亡是否可以解释老年期抑郁症状的增加。
纵向研究。
社区。
该研究纳入了 2320 名参与者（47.0%为女性；基线时的平均[标准差]年龄为 58.1[17.0]岁；年龄范围为 19-95 岁），来自巴尔的摩老龄化纵向研究。
根据流行病学研究中心抑郁量表和 3 个子量表（抑郁情绪、躯体抱怨和人际问题），对 10,982 次评估中的抑郁症状进行建模，以估计抑郁症状的轨迹（每位参与者的平均[标准差]评估次数为 4.7[3.6]次；范围为 1-21 次）。
线性（γ10=0.52；P<.01）和二次（γ20=0.43；P<.01）项均具有统计学意义，表明抑郁症状在青年期最高，在中年期下降，在老年期再次升高。子量表也呈现出类似的模式。女性在年轻时报告的抑郁情绪更多，但年龄的交互作用表明，这种差距在老年时消失。考虑到共病、功能限制和即将死亡，略微降低但并未消除老年期抑郁症状的上升。
抑郁症状在成年期呈 U 型模式。老年人的痛苦增加，这不仅仅是由于身体健康下降或接近死亡所致。
