Hajek André, Brettschneider Christian, Ernst Annette, Lange Carolin, Wiese Birgitt, Prokein Jana, Weyerer Siegfried, Werle Jochen, Pentzek Michael, Fuchs Angela, Stein Janine, Bickel Horst, Mösch Edelgard, Heser Kathrin, Jessen Frank, Maier Wolfgang, Scherer Martin, Riedel-Heller Steffi G, König Hans-Helmut
Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
Qual Life Res. 2015 Nov;24(11):2713-22. doi: 10.1007/s11136-015-1005-8. Epub 2015 May 19.
To investigate the coevolution of depression and health-related quality of life (HRQoL) in old age.
In a representative survey of the German general population aged 75 years and older, the course of HRQoL and depression was observed over 4.5 years (3 waves). HRQoL was assessed by the Visual Analogue Scale (EQ VAS) of the EQ-5D instrument, while the Geriatric Depression Scale was used to measure depression. A panel vector autoregressive model was used to account for the complex coevolution of depression and HRQoL. Unobserved heterogeneity was taken into account by taking the first differences.
We revealed a robust negative association between an initial change in HRQoL and a subsequent change in depression score, with substantial sex differences: In women there was a robust association, while in men the significance of this association depended on the model specification. Surprisingly, in the total sample and in both sexes, no robust association between an initial increase in depression and a subsequent change in HRQoL was found.
Findings indicate that the direction of evolution from HRQoL to depression deserves more attention. Furthermore, treatment of depression in late life should aim at improving HRQoL in which remission of depressive symptoms is necessary but not sufficient.
研究老年期抑郁症与健康相关生活质量（HRQoL）的共同演变。
在一项对75岁及以上德国普通人群的代表性调查中，观察了4.5年（3次随访）期间HRQoL和抑郁症的病程。HRQoL通过EQ-5D工具的视觉模拟量表（EQ VAS）进行评估，而老年抑郁量表用于测量抑郁症。使用面板向量自回归模型来解释抑郁症和HRQoL的复杂共同演变。通过取一阶差分考虑未观察到的异质性。
我们发现HRQoL的初始变化与随后抑郁症评分的变化之间存在强烈的负相关，且存在显著的性别差异：在女性中存在强烈关联，而在男性中这种关联的显著性取决于模型设定。令人惊讶的是，在总样本以及男女两性中，未发现抑郁症的初始增加与随后HRQoL的变化之间存在强烈关联。
研究结果表明，从HRQoL到抑郁症的演变方向值得更多关注。此外，老年期抑郁症的治疗应旨在改善HRQoL，其中抑郁症状的缓解是必要的但并不充分。
