Schutter N, Holwerda T J, Stek M L, Dekker J J M, Rhebergen D, Comijs H C
Arkin Mental Health Care, Department of Geriatric Psychiatry, Nieuwe Kerkstraat 156, 1018 VM Amsterdam, The Netherlands.
Arkin Mental Health Care, Department of Geriatric Psychiatry, Nieuwe Kerkstraat 156, 1018 VM Amsterdam, The Netherlands.
J Psychosom Res. 2017 Apr;95:19-25. doi: 10.1016/j.jpsychores.2017.02.002. Epub 2017 Feb 7.
Loneliness in older adults has been associated with increased mortality and health problems. One of the assumed underlying mechanisms is dysregulation of the hypothalamic-pituitary-adrenocortical axis (HPA-axis). The purpose of this study was to investigate whether loneliness in older adults is associated with HPA-axis dysregulation and whether this association differs between depressed and non-depressed persons.
Cross-sectional data of 426 lonely and non-lonely older adults in the Netherlands Study of Depression in Older Persons (NESDO) were used. Linear regression analyses and multinominal logistic regression analyses were performed to examine the association between loneliness and morning cortisol, cortisol awakening response, diurnal slope and dexamethasone suppression ratio. In all analyses, confounders were introduced. In order to examine whether the association between loneliness and cortisol measures is different in depressed versus non-depressed persons, an interaction term for loneliness x depression diagnosis was tested.
Cortisol output in the first hour after awakening and dexamethasone suppression ratio was lower in lonely participants. There were no significant interactions between loneliness and depression diagnosis in the association with the cortisol measures.
This study is the first to investigate the association between the HPA-axis and loneliness in a large group of older adults aged 60-93years. We found lower cortisol output in the first hour after awakening and lower dexamethasone suppression ratio in lonely older depressed and non-depressed adults. Whether diminished cortisol output is the underlying mechanism that leads to health problems in lonely older adults is an interesting object for further study.
老年人的孤独感与死亡率增加及健康问题有关。一种假定的潜在机制是下丘脑 - 垂体 - 肾上腺皮质轴（HPA轴）失调。本研究的目的是调查老年人的孤独感是否与HPA轴失调有关，以及这种关联在抑郁和非抑郁人群之间是否存在差异。
使用荷兰老年人抑郁症研究（NESDO）中426名孤独和非孤独老年人的横断面数据。进行线性回归分析和多项逻辑回归分析，以检验孤独感与早晨皮质醇、皮质醇觉醒反应、昼夜斜率和地塞米松抑制率之间的关联。在所有分析中，引入了混杂因素。为了检验孤独感与皮质醇测量值之间的关联在抑郁与非抑郁人群中是否不同，对孤独感×抑郁诊断的交互项进行了检验。
孤独参与者觉醒后第一小时的皮质醇分泌量和地塞米松抑制率较低。在与皮质醇测量值的关联中，孤独感与抑郁诊断之间没有显著的交互作用。
本研究首次在一大群60 - 93岁的老年人中调查了HPA轴与孤独感之间的关联。我们发现孤独的老年抑郁和非抑郁成年人在觉醒后第一小时的皮质醇分泌量较低，地塞米松抑制率也较低。皮质醇分泌量减少是否是导致孤独老年人出现健康问题的潜在机制，是一个值得进一步研究的有趣课题。
