Walker J, Liddle J, Jordan K P, Campbell P
School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Keele, Staffordshire, UK.
Arthritis Research UK Primary Care Centre, Institute for Primary Care and Health Sciences, Keele University, Keele, ST5 5BG, UK.
BMC Psychiatry. 2017 May 19;17(1):190. doi: 10.1186/s12888-017-1354-7.
Depression and anxiety are common and have a significant impact on the individual and wider society. One theory proposed to explain a heightened risk for depression and anxiety is affective concordance in couples (e.g. influence of shared mood states, shared health beliefs). Whilst research has shown concordance for severe psychiatric illnesses and general mood in couples, little attention has been given to concordance for common psychiatric conditions such as depression and anxiety. The aims of this study were to test affective concordance in couples and examine potential influences on concordance.
Study design is a 1-year cross-sectional study of anxiety and depression consultations in primary care. Data were obtained from a validated primary care database of recorded consultations. Outcome was the presence of an anxiety or depression Read Code (GP recorded reason for consultation) in the female (within the couple dyad), and exposure was a recorded Read Code of anxiety or depression in the male. Logistic regression was used to test associations with odds ratios (OR) and 95% confidence intervals (95% CI) reported. Statistical adjustment was carried out on potential influences of concordance; age, environment (deprivation), healthcare behaviour (consultation frequency), and comorbidity.
A population of 13,507 couples were identified in which 927 people consulted for anxiety and 538 for depression. Logistic regression showed a 3 times increase in odds of an anxiety consultation in females if their male partner had also consulted OR 2.98 (95% CI 2.15 to 4.13). For depression females were over 4 times the odds of consulting if their male partner had also consulted OR 4.45 (95% CI 2.79 to 7.09). Adjustment within a multivariable model showed some reduction in odds; concordant anxiety was reduced to 2.5 times odds OR 2.48 (95%CI 1.76 to 3.50) and depression reduced to OR 3.39 (2.07 to 5.54).
Results show significant associations for affective concordance in couples. Factors influencing concordance are comorbidity and environmental factors, however reasons for deciding to consult (positive or negative) are unknown. This study highlights the patients' social context as a factor in consultations for anxiety and depression and gives support to the consideration of the patient's household as an influence on mental health.
抑郁和焦虑很常见，对个人及更广泛的社会都有重大影响。一种用来解释抑郁和焦虑风险增加的理论是夫妻间的情感一致性（例如共享情绪状态、共享健康信念的影响）。虽然研究表明夫妻在严重精神疾病和总体情绪方面存在一致性，但对于抑郁和焦虑等常见精神状况的一致性关注较少。本研究的目的是检验夫妻间的情感一致性，并探讨对一致性的潜在影响。
研究设计为一项对初级保健中焦虑和抑郁咨询进行的为期1年的横断面研究。数据来自一个经过验证的记录咨询的初级保健数据库。结局是女性（夫妻二元组中）存在焦虑或抑郁的Read编码（全科医生记录的咨询原因），暴露因素是男性记录的焦虑或抑郁的Read编码。使用逻辑回归来检验关联，并报告比值比（OR）和95%置信区间（95%CI）。对一致性的潜在影响进行了统计调整；年龄、环境（贫困程度）、医疗行为（咨询频率）和合并症。
共识别出13507对夫妻，其中927人因焦虑咨询过，538人因抑郁咨询过。逻辑回归显示，如果女性的男性伴侣也咨询过，那么女性因焦虑咨询的几率增加3倍，OR为2.98（95%CI为2.15至4.13）。对于抑郁，如果女性的男性伴侣也咨询过，那么女性咨询的几率是其4倍多，OR为4.45（95%CI为2.79至7.09）。多变量模型中的调整显示几率有所降低；一致性焦虑降至2.5倍几率，OR为2.48（95%CI为1.76至3.50），抑郁降至OR为3.39（2.07至5.54）。
结果显示夫妻间情感一致性存在显著关联。影响一致性的因素是合并症和环境因素，然而决定咨询（积极或消极）的原因尚不清楚。本研究强调了患者的社会背景是焦虑和抑郁咨询中的一个因素，并支持将患者家庭视为对心理健康有影响的因素。
