贝克抑郁量表的双因素模型及其与心肌梗死后医学预后的关联。
A bifactor model of the Beck Depression Inventory and its association with medical prognosis after myocardial infarction.
作者信息
de Miranda Azevedo Ricardo, Roest Annelieke M, Carney Robert M, Denollet Johan, Freedland Kenneth E, Grace Sherry L, Hosseini Seyed H, Lane Deirdre A, Parakh Kapil, Pilote Louise, de Jonge Peter
机构信息
Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Department of Psychiatry, University of Groningen, University Medical Center Groningen.
Department of Psychiatry, Washington University School of Medicine.
出版信息
Health Psychol. 2016 Jun;35(6):614-24. doi: 10.1037/hea0000316. Epub 2016 Feb 22.
OBJECTIVES
Evidence suggests that depression is associated with adverse outcomes in patients with myocardial infarction (MI). Some of the symptoms of depression may also be symptoms of somatic illness and these may confound the association between depression and prognosis. We investigated whether depression following MI is associated with medical prognosis independent of these somatic symptoms.
METHOD
The database of an individual patient data meta-analysis was used. Endpoints were all-cause mortality and cardiovascular events. Nine studies were included. Bifactor factor analysis included 13,100 participants and 7,595 participants were included in survival models. Dimensions were generated from the Beck Depression Inventory using factor analyses. The prognostic association was assessed using mixed-effects Cox regression analysis.
RESULTS
A bifactor model, consisting of a general factor and 2 general depression-free subgroup factors (a somatic/affective and a cognitive/affective), provided the best fit. There was a significant association between the general depression factor and all-cause mortality (hazard ratio [HR] = 1.25; 95% confidence interval [CI] [1.17, 1.34], p < .001) and cardiovascular events (HR = 1.18; 95% CI [1.13, 1.23], p < .001). After adjustment for demographics, measures of cardiac disease severity, and health-related variables, the association between the general depression factor and all-cause mortality (HR = 1.14; 95% CI [1.04, 1.25], p = .003) and cardiovascular events (HR = 1.16; 95% CI [1.10, 1.23], p = .014) attenuated. Additionally, the general depression-free somatic/affective factor was significantly associated with the endpoints, while the general depression-free cognitive/affective was not.
CONCLUSIONS
A general depression factor is associated with adverse medical prognosis following MI independent of somatic/affective symptoms that may be partly attributable to somatic illness. (PsycINFO Database Record
目的
有证据表明，抑郁症与心肌梗死（MI）患者的不良预后相关。抑郁症的一些症状也可能是躯体疾病的症状，这些症状可能会混淆抑郁症与预后之间的关联。我们调查了心肌梗死后的抑郁症是否与这些躯体症状无关的医学预后相关。
方法
使用个体患者数据荟萃分析的数据库。终点为全因死亡率和心血管事件。纳入了9项研究。双因素分析纳入了13100名参与者，生存模型纳入了7595名参与者。使用因子分析从贝克抑郁量表中生成维度。使用混合效应Cox回归分析评估预后关联。
结果
一个由一个一般因子和两个无一般抑郁的亚组因子（一个躯体/情感因子和一个认知/情感因子）组成的双因素模型拟合效果最佳。一般抑郁因子与全因死亡率（风险比[HR]=1.25；95%置信区间[CI][1.17,1.34]，p<.001）和心血管事件（HR=1.18；95%CI[1.13,1.23]，p<.001）之间存在显著关联。在对人口统计学、心脏病严重程度测量和健康相关变量进行调整后，一般抑郁因子与全因死亡率（HR=1.14；95%CI[1.04,1.25]，p=.003）和心血管事件（HR=1.16；95%CI[1.10,1.23]，p=.014）之间的关联减弱。此外，无一般抑郁的躯体/情感因子与终点显著相关，而无一般抑郁的认知/情感因子则不然。
结论
一般抑郁因子与心肌梗死后不良的医学预后相关，与可能部分归因于躯体疾病的躯体/情感症状无关。（PsycINFO数据库记录）
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