Geriatric Research, Education and Clinical Center, VA Maryland Health Care System, Baltimore, MD, USA.
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.
Int J Geriatr Psychiatry. 2018 Jul;33(7):875-882. doi: 10.1002/gps.4864. Epub 2018 Feb 26.
Depression after hip fracture in older adults is associated with worse physical performance; however, depressive symptoms are dynamic, fluctuating during the recovery period. The study aim was to determine how the persistence of depressive symptoms over time cumulatively affects the recovery of physical performance.
Marginal structural models estimated the cumulative effect of persistence of depressive symptoms on gait speed during hip fracture recovery among older adults (n = 284) enrolled in the Baltimore Hip Studies 7th cohort. Depressive symptoms at baseline and at 2-month and 6-month postadmission for hip fracture were evaluated by using the Center for Epidemiological Studies Depression Scale, and persistence of symptoms was assessed as a time-averaged severity lagged to standardized 3 m gait speed at 2, 6, and 12 months.
A 1-unit increase in time-averaged Center for Epidemiological Studies Depression score was associated with a mean difference in gait speed of -0.0076 standard deviations (95% confidence interval [CI]: -0.0184, 0.0032; P = .166). The association was largest in magnitude from baseline to 6 months: -0.0144 standard deviations (95% CI: -0.0303, 0.0015; P = 0.076). Associations for the other time intervals were smaller: -0.0028 standard deviations (95% CI: -0.0138, 0.0083; P = .621) at 2 months and -0.0121 standard deviations (95% CI: -0.0324, 0.0082; P = .238) at 12 months.
Although not statistically significant, the magnitude of the numerical estimates suggests that expressing more depressive symptoms during the first 6 months after hip fracture has a meaningful impact on functional recovery.
老年人髋部骨折后出现抑郁与较差的身体机能有关；然而，抑郁症状是动态的，在康复期间会波动。本研究旨在确定随着时间推移，抑郁症状的持续存在如何对身体机能的恢复产生累积影响。
Marginal structural 模型估计了在巴尔的摩髋部研究第 7 队列中接受髋部骨折治疗的老年人（n=284）中，抑郁症状持续存在对髋部骨折康复期间步态速度的累积影响。使用流行病学研究中心抑郁量表评估基线时和入院后 2 个月及 6 个月的抑郁症状，通过时间平均严重程度滞后于标准化 3 米步态速度来评估症状的持续存在，滞后时间分别为 2、6 和 12 个月。
时间平均流行病学研究中心抑郁评分增加 1 个单位与步态速度的平均差异为-0.0076 个标准差（95%置信区间：-0.0184，0.0032；P=0.166）。从基线到 6 个月时，这种关联的幅度最大，为-0.0144 个标准差（95%置信区间：-0.0303，0.0015；P=0.076）。其他时间间隔的关联较小：2 个月时为-0.0028 个标准差（95%置信区间：-0.0138，0.0083；P=0.621），12 个月时为-0.0121 个标准差（95%置信区间：-0.0324，0.0082；P=0.238）。
尽管没有统计学意义，但数值估计的幅度表明，在髋部骨折后最初 6 个月内表达更多的抑郁症状对功能恢复有重要影响。
