Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; Center for Research on Ethnicity, Culture and Health, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
Mental Health Research Center, Tehran Psychiatric Institute, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences , Tehran , Iran.
Front Public Health. 2016 Mar 17;4:40. doi: 10.3389/fpubh.2016.00040. eCollection 2016.
Despite the well-established association between baseline depressive symptoms and risk of all cause-mortality, limited information exists on racial differences in the residual effects of baseline depressive symptoms above and beyond socioeconomic status (SES) and physical health on this link. The current study compared Blacks and Whites for the residual effects of depressive symptoms over SES and health on risk of long-term all-cause mortality in the U.S.
Data were obtained from the Americans' Changing Lives Study, a nationally representative longitudinal cohort of U.S. adults with up to 25 years of follow-up. The study followed 3,361 Blacks and Whites for all-cause mortality between 1986 and 2011. The main predictor of interest was baseline depressive symptoms measured at 1986 using an 11-item Center for Epidemiological Studies-Depression scale. Covariates included baseline demographics (age and gender), SES (education and income), and health [chronic medical conditions (CMCs), self-rated health (SRH), and body mass index (BMI)] measured at 1986. Race (Black versus White) was the focal moderator. We ran a series of Cox proportional hazard models in the pooled sample and also stratified by race.
In the pooled sample, higher depressive symptoms at baseline were associated with higher risk of all-cause mortality except when the CMC, SRH, and BMI were added to the model. In this later model, race interacted with baseline depressive symptoms, suggesting a larger effect of depressive symptoms on mortality among Whites compared to Blacks. Among Whites, depressive symptoms were associated with increased risk of mortality, after controlling for SES but not after controlling for health (CMC, SRH, and BMI). Among Blacks, depressive symptoms were not associated with mortality before health was introduced to the model. After controlling for health, baseline depressive symptoms showed an inverse association with all-cause mortality among Blacks. Although the effect of baseline depressive symptoms on mortality disappeared after controlling for health among Whites, SRH did not interfere (confound) with the effect of depressive symptoms on mortality among Blacks.
The effect of depressive symptoms on increased risk of all-cause mortality, which existed among Whites, could not be found for Blacks. In addition, race may modify the roles that SES and health play regarding the link between depressive symptoms and mortality over a long period of time.
尽管基线抑郁症状与全因死亡率之间存在明确关联，但关于基线抑郁症状在社会经济地位（SES）和身体健康之外对这一关联的剩余影响在不同种族之间存在差异的信息有限。本研究比较了黑人和白人在 SES 和健康对美国长期全因死亡率影响的基础上，抑郁症状的剩余影响。
数据来自美国生活变化研究，这是一项具有全国代表性的美国成年人纵向队列研究，随访时间长达 25 年。该研究对 1986 年至 2011 年间的 3361 名黑人和白人进行了全因死亡率随访。主要预测因素为 1986 年使用 11 项中心流行病学研究-抑郁量表测量的基线抑郁症状。协变量包括基线人口统计学因素（年龄和性别）、SES（教育和收入）和健康[慢性疾病（CMCs）、自我报告的健康状况（SRH）和体重指数（BMI）]。种族（黑人与白人）是焦点调节剂。我们在汇总样本中运行了一系列 Cox 比例风险模型，并按种族进行了分层。
在汇总样本中，基线时较高的抑郁症状与全因死亡率风险增加相关，除非在模型中加入 CMC、SRH 和 BMI。在这个后一个模型中，种族与基线抑郁症状相互作用，表明抑郁症状对白人的死亡率影响大于黑人。在白人中，在控制 SES 但不控制健康（CMC、SRH 和 BMI）后，抑郁症状与死亡率增加相关。在黑人中，在引入健康模型之前，抑郁症状与死亡率无关。在控制健康因素后，黑人的基线抑郁症状与全因死亡率呈负相关。虽然在控制白人健康因素后，基线抑郁症状对死亡率的影响消失，但 SRH 并没有干扰（混淆）黑人抑郁症状对死亡率的影响。
在白人中存在的抑郁症状对全因死亡率增加的影响，在黑人中并未发现。此外，种族可能会改变 SES 和健康在长期内对抑郁症状与死亡率之间关系的作用。
