老年期抑郁症超额死亡率的长期趋势。

Secular trends in excess mortality of late-life depression.

机构信息

Department of Psychiatry, GGZ inGeest - VU University Medical Center, Amsterdam, The Netherlands; Department of Epidemiology and Biostatistics and the Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands.

出版信息

J Affect Disord. 2018 Jul;234:28-33. doi: 10.1016/j.jad.2018.02.068. Epub 2018 Feb 27.

DOI:10.1016/j.jad.2018.02.068

PMID:29522940

Abstract

BACKGROUND

Late-life depression is associated with premature mortality, however, little is known whether excess mortality rates of depression have changed over time. This study aims to identify and explain secular trends in excess mortality of major depressive disorder (MDD) and subthreshold depression (SUBD).

METHODS

Cohort-sequential-longitudinal study of 4084 community-dwelling older adults in the Netherlands based on data from the Longitudinal Aging Study Amsterdam (LASA). Six measurement cycles were included from 1992/93 until 2008/09, each linked to the overall 5-year mortality, covering a 16-year time span. MDD and SUBD were identified using a two-stage screening procedure with the Center for Epidemiological Studies Depression Scale and the Diagnostic Interview Schedule. Age and sex were covariates. Education, health and lifestyle factors, and use of antidepressants were included as putative explanatory factors. Generalized Estimating Equations was used to investigate the association between the interaction 'Depression × Time' and 5-year mortality, and to find explanatory factors for the trend.

RESULTS

A downward trend in excess mortality of MDD was found (OR = .92, 95%-CI:.85-.99, P = .04), adjusted for age and sex, which could not be explained by education, health and lifestyle factors, nor antidepressants use. Sex differences in the trend were not found (P = .77). No trend in excess mortality of SUBD was found (OR = 1.01, 95%-CI: .97-1.04, P = .65).

LIMITATIONS

The findings do not imply a similar trend for other countries.

CONCLUSIONS

The results indicate a favorable development in excess mortality of community-dwelling older adults with MDD, while those with SUBD do not show a clear trend in excess mortality.

摘要

背景

老年期抑郁症与过早死亡相关，然而，人们对于抑郁症的超额死亡率是否随时间变化知之甚少。本研究旨在确定并解释重性抑郁障碍（MDD）和阈下抑郁（SUBD）的超额死亡率的长期变化趋势。

方法

这是一项基于荷兰阿姆斯特丹纵向老龄化研究（LASA）数据的 4084 名社区居住的老年人的队列序贯纵向研究。共纳入了从 1992/93 年到 2008/09 年的 6 个测量周期，每个周期均与总体 5 年死亡率相关，涵盖了 16 年的时间跨度。使用中心流行病学研究抑郁量表和诊断访谈量表的两阶段筛选程序来识别 MDD 和 SUBD。年龄和性别为协变量。将教育、健康和生活方式因素以及抗抑郁药的使用作为潜在的解释因素纳入研究。使用广义估计方程来研究“抑郁×时间”的交互作用与 5 年死亡率之间的关联，并寻找趋势的解释因素。

结果

发现 MDD 的超额死亡率呈下降趋势（OR=0.92，95%CI：0.85-0.99，P=0.04），调整了年龄和性别因素后，这一趋势不能用教育、健康和生活方式因素或抗抑郁药的使用来解释。未发现趋势存在性别差异（P=0.77）。SUBD 的超额死亡率无明显趋势（OR=1.01，95%CI：0.97-1.04，P=0.65）。