Wielaard Ilse, Comijs Hannie C, Stek Max L, Rhebergen Didi
GGZ inGeest / Department of Psychiatry and Amsterdam Public Health research institute, Department of Mental Health, VU University Medical Centre, Amsterdam, The Netherlands.
GGZ inGeest / Department of Psychiatry and Amsterdam Public Health research institute, Department of Mental Health, VU University Medical Centre, Amsterdam, The Netherlands.
Am J Geriatr Psychiatry. 2017 Jun;25(6):633-643. doi: 10.1016/j.jagp.2017.01.014. Epub 2017 Jan 24.
Late-life depression often has a chronic course, with debilitating effects on functioning and quality of life; there is still no consensus on important risk factors explaining this chronicity. Cross-sectional studies have shown that childhood abuse is associated with late-life depression, and in longitudinal studies with chronicity of depression in younger adults. We aim to investigate the impact of childhood abuse on the course of late-life depression.
Two-year longitudinal cohort study.
Data were derived from the Netherlands Study of Depression in Older Persons (NESDO).
282 participants with a depression diagnosis in the previous 6 months (mean age: 70.6 years), of whom 152 (53.9%) experienced childhood abuse.
Presence of childhood abuse (yes/no) and a frequency-based childhood abuse index (CAI) were calculated. Dependent variable was depression diagnosis after 2 years.
Multivariable mediation analysis showed an association between childhood abuse and depression diagnosis at follow-up. Depression severity, age at onset, neuroticism, and number of chronic diseases were important mediating variables of this association, which then lost statistical significance. For childhood abuse (yes/no), loneliness was an additional, significant mediator. Depression severity was the main mediating variable, reducing the direct effect by 26.5% to 33.3% depending on the definition of abuse (respectively, 'yes/no" abuse and CAI).
More depressive symptoms at baseline, lower age at depression onset, higher levels of neuroticism and loneliness, and more chronic diseases explain a poor course of depression in older adults who reported childhood abuse. When treating late-life depression it is important to detect childhood abuse and consider these mediating variables.
晚年抑郁症通常病程呈慢性，对功能和生活质量有削弱作用；关于解释这种慢性病程的重要危险因素仍未达成共识。横断面研究表明，童年期受虐与晚年抑郁症有关，而纵向研究则显示其与年轻成年人抑郁症的慢性病程有关。我们旨在调查童年期受虐对晚年抑郁症病程的影响。
为期两年的纵向队列研究。
数据源自荷兰老年人抑郁症研究（NESDO）。
282名在过去6个月内被诊断为抑郁症的参与者（平均年龄：70.6岁），其中152人（53.9%）曾经历童年期受虐。
计算童年期受虐的存在情况（是/否）以及基于频率的童年期受虐指数（CAI）。因变量为2年后的抑郁症诊断。
多变量中介分析显示，童年期受虐与随访时的抑郁症诊断之间存在关联。抑郁严重程度、发病年龄、神经质以及慢性病数量是该关联的重要中介变量，之后这些变量失去统计学意义。对于童年期受虐（是/否），孤独感是另一个显著的中介变量。抑郁严重程度是主要的中介变量，根据受虐的定义（分别为“是/否”受虐和CAI），直接效应降低了26.5%至33.3%。
基线时更多的抑郁症状、较低的抑郁症发病年龄、较高的神经质和孤独感水平以及更多的慢性病，解释了报告有童年期受虐的老年人抑郁症病程不佳的情况。在治疗晚年抑郁症时，重要的是要发现童年期受虐情况并考虑这些中介变量。
