Almeida Osvaldo P, Hankey Graeme J, Yeap Bu B, Golledge Jonathan, Norman Paul E, Flicker Leon
School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia; WA Center for Health and Aging, Center for Medical Research, Perth, Australia; Department of Psychiatry, Royal Perth Hospital, Perth, Australia.
School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Department of Neurology, Sir Charles Gairdner Hospital, Perth, Australia.
J Am Med Dir Assoc. 2015 Apr;16(4):296-300. doi: 10.1016/j.jamda.2014.10.023. Epub 2014 Dec 10.
Depression is associated with increased mortality, but it is unclear if this relationship is truly causal.
To determine the relative mortality associated with past and current depression, taking into account the effect of frailty.
DESIGN, SETTING, AND PARTICIPANTS: Prospective longitudinal cohort study of 2565 men aged 75 years or over living in metropolitan Perth, Western Australia, who completed the third wave of assessments of the Health In Men Study throughout 2008.
All-cause mortality data were derived from Australian death records up to June 17, 2013. History of past depression and age of onset of symptoms were obtained from direct questioning and from electronic health record linkage. Diagnosis of current major depressive symptoms followed Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision guidelines. We considered that participants were frail if they showed evidence of impairment in 3 or more of the 5 domains on the fatigue, resistance, ambulation, illnesses, and loss of weight (FRAIL) scale. Other measured factors included age, education, living arrangements, smoking and alcohol history, and physical activity.
558 participants died during mean period of follow-up of 4.2 ± 1.1 years. The annual death rate per thousand was 50 for men without depression, 52 for men with past depression, and 201 for men with major depressive symptoms at baseline. The crude mortality hazard was 4.26 (95% confidence interval = 2.98, 6.09) for men with depression at baseline compared with never depressed men, and 1.79 (95% confidence interval = 1.21, 2.62) after adjustment for frailty. Further decline in mortality hazard was observed after adjustment for other measured factors.
Current, but not past, depression is associated with increased mortality, and this excess mortality is strongly associated with frailty. Interventions designed to decrease depression-related mortality in later life may need to focus on ameliorating frailty in addition to treating depression.
抑郁症与死亡率增加有关，但这种关系是否为真正的因果关系尚不清楚。
考虑到衰弱的影响，确定与过去和当前抑郁症相关的相对死亡率。
设计、设置和参与者：对居住在西澳大利亚州珀斯市的2565名75岁及以上男性进行前瞻性纵向队列研究，这些男性在2008年完成了男性健康研究的第三次评估。
全因死亡率数据来自截至2013年6月17日的澳大利亚死亡记录。过去抑郁症病史和症状出现年龄通过直接询问和电子健康记录链接获得。当前重度抑郁症状的诊断遵循《精神疾病诊断与统计手册》第4版，文本修订版指南。如果参与者在疲劳、抵抗力、步行、疾病和体重减轻（FRAIL）量表的5个领域中的3个或更多领域显示出受损迹象，我们认为他们是衰弱的。其他测量因素包括年龄、教育程度、生活安排、吸烟和饮酒史以及身体活动。
在平均4.2±1.1年的随访期内，558名参与者死亡。无抑郁症男性的年死亡率为每千人50例，有过抑郁症男性为52例，基线时有重度抑郁症状的男性为201例。与从未患抑郁症的男性相比，基线时有抑郁症的男性的粗死亡率风险为4.26（95%置信区间=2.98，6.09），在调整衰弱因素后为1.79（95%置信区间=1.21，2.62）。在调整其他测量因素后，死亡率风险进一步下降。
当前而非过去的抑郁症与死亡率增加有关，且这种额外的死亡率与衰弱密切相关。旨在降低晚年与抑郁症相关死亡率的干预措施可能除了治疗抑郁症外，还需要侧重于改善衰弱状况。
