Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Nutrition and Food Hygiene, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
J Affect Disord. 2018 Jul;234:59-66. doi: 10.1016/j.jad.2018.02.052. Epub 2018 Feb 17.
We aimed to prospectively evaluate the association between major depressive episode (MDE) and risk of type 2 diabetes in a Chinese population.
We used data from the China Kadoorie Biobank study, in which 461,213 participants free of diabetes, coronary heart disease, stroke, and cancer were followed from baseline (2004-2008) to December 31, 2013. A modified Chinese version of Composite International Diagnostic Interview Short-Form (CIDI-SF) was used to assess past year MDE. Participants who responded positive to depression screening questions but did not meet the diagnosis criteria were considered as having depressive symptoms only. Incident diabetes cases were identified through linkage with established regional disease registries and national health insurance databases. Cox proportional hazards regression model was used to calculate hazard ratio (HR) and 95% confidence interval (CI) for the association after adjusting for diabetes risk factors.
We documented 8784 incident type 2 diabetes cases during a follow-up of 3291,908 person-years. We observed a higher incidence rate of type 2 diabetes in participants with MDE than those without, and the multivariable-adjusted HR was 1.31 (95% CI 1.04-1.66). Compared with participants without depressive symptoms, the HR (95% CI) was 1.19 (1.05-1.35) for participants with depressive symptoms only and 1.32 (1.05-1.68) for those with MDE.
The prevelance of past year MDE based on CIDI-SF was low, which might result in a selection bias.
In our large prospective cohort study of Chinese adults, MDE was significantly and independently associated with an increased risk of type 2 diabetes.
我们旨在前瞻性评估中国人群中重度抑郁发作（MDE）与 2 型糖尿病风险之间的关系。
我们使用了中国慢性病前瞻性研究（CKB）的数据，该研究纳入了 461213 名无糖尿病、冠心病、卒中和癌症的参与者，随访时间从基线（2004-2008 年）到 2013 年 12 月 31 日。采用改良后的中文版复合国际诊断访谈短表（CIDI-SF）评估过去一年的 MDE。对回答抑郁筛查问题阳性但不符合诊断标准的参与者，仅诊断为存在抑郁症状。通过与已建立的区域疾病登记处和国家健康保险数据库的链接，确定新发生的糖尿病病例。使用 Cox 比例风险回归模型计算调整糖尿病危险因素后 MDE 与风险比（HR）及其 95%置信区间（CI）。
在 3291908 人年的随访期间，我们记录了 8784 例 2 型糖尿病新发病例。与无 MDE 的参与者相比，MDE 参与者的 2 型糖尿病发生率更高，多变量调整后的 HR 为 1.31（95%CI 1.04-1.66）。与无抑郁症状的参与者相比，仅存在抑郁症状的参与者的 HR（95%CI）为 1.19（1.05-1.35），MDE 参与者的 HR（95%CI）为 1.32（1.05-1.68）。
基于 CIDI-SF 的过去一年 MDE 患病率较低，可能导致选择偏倚。
在我们对中国成年人进行的大型前瞻性队列研究中，MDE 与 2 型糖尿病风险显著且独立相关。
