Teismann Henning, Wersching Heike, Nagel Maren, Arolt Volker, Heindel Walter, Baune Bernhard T, Wellmann Jürgen, Hense Hans-Werner, Berger Klaus
Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany.
BMC Psychiatry. 2014 Jun 13;14:174. doi: 10.1186/1471-244X-14-174.
Depression and cardiovascular diseases due to arteriosclerosis are both frequent and impairing conditions. Depression and (subclinical) arteriosclerosis appear to be related in a bidirectional way, and it is plausible to assume a partly joint causal relationship. However, the biological mechanisms and the behavioral pathways that lead from depression to arteriosclerosis and vice versa remain to be exactly determined.
METHODS/DESIGN: This study protocol describes the rationale and design of the prospective BiDirect Study that aims at investigating the mutual relationship between depression and (subclinical) arteriosclerosis. BiDirect is scheduled to follow-up three distinct cohorts of individuals ((i) patients with acute depression (N = 999), (ii) patients after an acute cardiac event (N = 347), and (iii) reference subjects from the general population (N = 912)). Over the course of 12 years, four personal examinations are planned to be conducted. The core examination program, which will remain identical across follow-ups, comprises a personal interview (e.g. medical diagnoses, health care utilization, lifestyle and risk behavior), a battery of self-administered questionnaires (e.g. depressive symptoms, readiness to change health behavior, perceived health-related quality of life), sensory (e.g. olfaction, pain) and neuropsychological (e.g. memory, executive functions, emotional processing, manual dexterity) assessments, anthropometry, body impedance measurement, a clinical work-up regarding the vascular status (e.g. electrocardiogram, blood pressure, intima media thickness), the taking of blood samples (serum and plasma, DNA), and structural and functional resonance imaging of the brain (e.g. diffusion tensor imaging, resting-state, emotional faces processing). The present report includes BiDirect-Baseline, the first data collection wave.
Due to its prospective character, the integration of three distinct cohorts, the long follow-up time window, the diligent diagnosis of depression taking depression subtypes into account, the consideration of relevant comorbidities and risk factors, the assessment of indicators of (subclinical) arteriosclerosis in different vascular territories, and the structural and functional brain imaging that is performed for a large number of participants, the BiDirect Study represents an innovative approach that combines population-based cohorts with sophisticated clinical work-up methods and that holds the potential to overcome many of the drawbacks characterizing earlier investigations.
抑郁症和因动脉硬化导致的心血管疾病都是常见且会造成损害的病症。抑郁症与（亚临床）动脉硬化似乎以双向方式相关联，并且假定存在部分共同的因果关系是合理的。然而，从抑郁症到动脉硬化以及反之从动脉硬化到抑郁症的生物学机制和行为途径仍有待确切确定。
方法/设计：本研究方案描述了前瞻性双向研究的基本原理和设计，该研究旨在调查抑郁症与（亚临床）动脉硬化之间的相互关系。双向研究计划对三组不同的个体进行随访：（i）急性抑郁症患者（N = 999），（ii）急性心脏事件后的患者（N = 347），以及（iii）来自普通人群的对照受试者（N = 912）。在12年的时间里，计划进行四次个体检查。核心检查程序在每次随访中保持一致，包括个人访谈（如医学诊断、医疗保健利用情况、生活方式和风险行为）、一系列自我管理的问卷（如抑郁症状、改变健康行为的意愿、感知的与健康相关的生活质量）、感官（如嗅觉、疼痛）和神经心理学（如记忆、执行功能、情绪处理、手部灵巧性）评估、人体测量、身体阻抗测量、关于血管状况的临床检查（如心电图、血压、内膜中层厚度）、采集血样（血清和血浆、DNA）以及大脑的结构和功能磁共振成像（如扩散张量成像、静息状态、情绪面孔处理）。本报告包括双向研究的基线，即第一次数据收集阶段。
由于其前瞻性特点、三个不同队列的整合、较长的随访时间窗口、考虑抑郁症亚型的抑郁症的细致诊断、对相关合并症和危险因素的考虑、不同血管区域（亚临床）动脉硬化指标的评估以及对大量参与者进行的大脑结构和功能成像，双向研究代表了一种创新方法，它将基于人群的队列与复杂的临床检查方法相结合，并且有可能克服早期研究中存在的许多缺点。
