Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Government of Canada, Ottawa, Ontario, Canada.
Department of Social and Preventive Medicine, Université de Montréal, Montréal, Quebec, Canada.
Health Promot Chronic Dis Prev Can. 2016 Oct;36(10):205-213. doi: 10.24095/hpcdp.36.10.01.
Few studies have evaluated the impact of depression in terms of losses to both premature mortality and health-related quality of life (HRQOL) on the overall population. Health-adjusted life expectancy (HALE) is a summary measure of population health that combines both morbidity and mortality into a single summary statistic that describes the current health status of a population.
We estimated HALE for the Canadian adult population according to depression status. National Population Health Survey (NPHS) participants 20 years and older (n = 12 373) were followed for mortality outcomes from 1994 to 2009, based on depression status. Depression was defined as having likely experienced a major depressive episode in the previous year as measured by the Composite International Diagnostic Interview Short Form. Life expectancy was estimated by building period abridged life tables by sex and depression status using the relative risks of mortality from the NPHS and mortality data from the Canadian Chronic Disease Surveillance System (2007-2009). The Canadian Community Health Survey (2009/10) provided estimates of depression prevalence and Health Utilities Index as a measure of HRQOL. Using the combined mortality, depression prevalence and HRQOL estimates, HALE was estimated for the adult population according to depression status and by sex.
For the population of women with a recent major depressive episode, HALE at 20 years of age was 42.0 years (95% CI: 40.2-43.8) compared to 57.0 years (95% CI: 56.8-57.2) for women without a recent major depressive episode. For the population of Canadian men, HALE at 20 was 39.0 years (95% CI: 36.5-41.5) for those with a recent major depressive episode compared to 53.8 years (95% CI: 53.6-54.0) for those without. For the 15.0-year difference in HALE between women with and without depression, 12.3 years can be attributed to the HRQOL gap and the remaining 2.7 years to the mortality gap. The 14.8 fewer years of HALE observed for men with depression equated to a 13.0-year HRQOL gap and a 1.8-year mortality gap.
The population of adult men and women with depression in Canada had substantially lower healthy life expectancy than those without depression. Much of this gap is explained by lower levels of HRQOL, but premature mortality also plays a role.
很少有研究从过早死亡和与健康相关的生活质量（HRQOL）损失的角度评估抑郁症对整个人群的影响。健康调整后的预期寿命（HALE）是衡量人口健康的综合指标，它将发病率和死亡率结合到一个单一的综合统计数据中，描述了人口的当前健康状况。
我们根据抑郁状况评估了加拿大成年人口的 HALE。1994 年至 2009 年，基于抑郁状况，对年龄在 20 岁及以上的全国人口健康调查（NPHS）参与者进行了死亡率结局的随访。抑郁的定义是在过去一年中经历了一次主要的抑郁发作，这是通过使用复合国际诊断访谈简短形式进行测量的。通过构建性别和抑郁状态的时期缩短生命表，利用 NPHS 的死亡率相对风险和加拿大慢性病监测系统（2007-2009 年）的死亡率数据来估计预期寿命。加拿大社区健康调查（2009/10 年）提供了抑郁患病率和健康效用指数的估计，作为 HRQOL 的衡量标准。使用合并的死亡率、抑郁患病率和 HRQOL 估计值，根据抑郁状况和性别估计了成年人口的 HALE。
对于最近患有重度抑郁症的女性人群，20 岁时的 HALE 为 42.0 岁（95%CI：40.2-43.8），而最近未患有重度抑郁症的女性为 57.0 岁（95%CI：56.8-57.2）。对于加拿大男性人群，最近患有重度抑郁症的男性 20 岁时的 HALE 为 39.0 岁（95%CI：36.5-41.5），而最近未患有重度抑郁症的男性为 53.8 岁（95%CI：53.6-54.0）。在 HALE 方面，患有和不患有抑郁症的女性之间存在 15.0 年的差异，其中 12.3 年可归因于 HRQOL 差距，而剩余的 2.7 年归因于死亡率差距。观察到患有抑郁症的男性 HALE 减少了 14.8 年，相当于 HRQOL 差距为 13.0 年，死亡率差距为 1.8 年。
加拿大患有抑郁症的成年男性和女性的健康预期寿命明显低于没有抑郁症的人群。这种差距的很大一部分可以用较低的 HRQOL 水平来解释，但过早死亡也起了作用。
