Department of Psychiatry, University of Ottawa, Ottawa, Canada.
The Royal Ottawa Mental Health Centre, Ottawa, Canada.
Int J Geriatr Psychiatry. 2017 Sep;32(9):1000-1008. doi: 10.1002/gps.4559. Epub 2016 Aug 15.
To examine the relationship between psychological well-being and depression in older adults and the relative contribution these psychological factors have on risk of functional disability, frailty, and mortality.
This is a secondary analysis of 1668 community-dwelling older adults without dementia who participated in the second wave of the Canadian Study of Health and Aging. Baseline assessments of psychological well-being (Ryff scale) and depression (Geriatric Depression Scale; GDS) were collected. At 5-year follow-up, mortality data were collected; frailty and disability in activities of daily living were evaluated using the frailty index (FI) and the Lawton-Brody scale, respectively.
Area under the receiver-operating characteristic curve indicated that GDS and Ryff scores were able to independently discriminate whether individuals were considered frail (C = 0.66; C = 0.59, respectively), had limitations in basic (C = 0.64; C = 0.57, respectively) or instrumental (C = 0.70; C = 0.57, respectively) activities of daily living, or had died (C = 0.63; C = 0.57) at follow-up (all P < 0.01). Regression models in which the Ryff and GDS were included in the same model demonstrated that the GDS significantly predicted frailty, disability, and mortality, whereas the Ryff effect was not significant. Mediation analysis determined that the effect of psychological well-being on adverse outcomes was fully mediated by depression.
Our results suggest that although both depression and psychological well-being appear to modulate risk for adverse physical health outcomes, depression mediates this relationship. Detecting and treating depressive symptoms should be of high priority in older patients to mitigate risk of future physical health adversities including mortality. Copyright © 2016 John Wiley & Sons, Ltd.
探讨老年人心理幸福感与抑郁之间的关系，以及这些心理因素对功能障碍、虚弱和死亡风险的相对贡献。
这是对参加加拿大健康老龄化研究第二波的 1668 名无痴呆的社区居住老年人进行的二次分析。基线评估了心理幸福感（Ryff 量表）和抑郁（老年抑郁量表；GDS）。在 5 年的随访中，收集了死亡率数据；使用脆弱指数（FI）和劳顿-布罗迪量表分别评估了日常生活活动中的虚弱和残疾。
接收者操作特征曲线下的面积表明，GDS 和 Ryff 评分能够独立区分个体是否被认为虚弱（C = 0.66；C = 0.59，分别），在基本（C = 0.64；C = 0.57，分别）或工具性（C = 0.70；C = 0.57，分别）日常生活活动中存在限制，或在随访时死亡（C = 0.63；C = 0.57）（均 P < 0.01）。在将 Ryff 和 GDS 包含在同一个模型中的回归模型中，GDS 显著预测了虚弱、残疾和死亡，而 Ryff 的影响则不显著。中介分析确定，心理幸福感对不良结果的影响完全由抑郁介导。
我们的研究结果表明，尽管抑郁和心理幸福感似乎都能调节老年人不良身体健康结果的风险，但抑郁是这种关系的中介。在老年患者中，检测和治疗抑郁症状应高度优先考虑，以减轻未来包括死亡在内的身体健康不良事件的风险。版权所有©2016 约翰威立父子有限公司。
