Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
Ann Rheum Dis. 2019 May;78(5):688-695. doi: 10.1136/annrheumdis-2018-214676. Epub 2019 Mar 7.
There is inconsistent evidence about the association between inflammatory disorders and depression and anxiety onset in a primary care context. The study aimed to evaluate the risk of depression and anxiety within multisystem and organ-specific inflammatory disorders.
This is a prospective cohort study with primary care patients from the UK Clinical Practice Research Datalink diagnosed with an inflammatory disorder between 1 January 2001 and 31 December 2016. These patients were matched on age, gender, practice and index date with patients without an inflammatory disorder. The study exposures were seven chronic inflammatory disorders. Clinical diagnosis of depression and anxiety represented the outcome measures of interest.
Among 538 707 participants, the incidence of depression ranged from 14 per 1000 person-years (severe psoriasis) to 9 per 1000 person-years (systemic vasculitis), substantively higher compared with their comparison group (5-7 per 1000 person-years). HRs of multiple depression and anxiety events were 16% higher within inflammatory disorders (HR, 1.16, 95% CI 1.12 to 1.21, p<0.001) compared with the matched comparison group. The incidence of depression and anxiety was strongly associated with the age at inflammatory disorder onset. The overall HR estimate for depression was 1.90 (95% CI 1.66 to 2.17, p<0.001) within early-onset disorder (<40 years of age) and 0.93 (95% CI 0.90 to 1.09, p=0.80) within late-onset disorder (≥60 years of age).
Primary care patients with inflammatory disorders have elevated rates of depression and anxiety incidence, particularly those patients with early-onset inflammatory disorders. This finding may reflect the impact of the underlying disease on patients' quality of life, although the precise mechanisms require further investigation.
在初级保健环境中，炎症性疾病与抑郁和焦虑发病之间的关联证据并不一致。本研究旨在评估多系统和器官特异性炎症性疾病中抑郁和焦虑的风险。
这是一项前瞻性队列研究，纳入了 2001 年 1 月 1 日至 2016 年 12 月 31 日期间在英国临床实践研究数据链中被诊断为炎症性疾病的初级保健患者。这些患者按照年龄、性别、实践和指数日期与没有炎症性疾病的患者进行匹配。研究暴露为七种慢性炎症性疾病。抑郁和焦虑的临床诊断为感兴趣的结局指标。
在 538707 名参与者中，抑郁症的发病率范围为每 1000 人年 14 例（严重银屑病）至每 1000 人年 9 例（系统性血管炎），显著高于对照组（每 1000 人年 5-7 例）。与匹配的对照组相比，炎症性疾病患者的多重抑郁和焦虑事件的 HR 高出 16%（HR，1.16；95%CI，1.12 至 1.21；p<0.001）。抑郁和焦虑的发病率与炎症性疾病发病年龄密切相关。早期发病（<40 岁）的总体抑郁 HR 估计值为 1.90（95%CI，1.66 至 2.17，p<0.001），而晚期发病（≥60 岁）的 HR 估计值为 0.93（95%CI，0.90 至 1.09，p=0.80）。
患有炎症性疾病的初级保健患者抑郁和焦虑的发病率较高，尤其是那些早期发病的炎症性疾病患者。这一发现可能反映了潜在疾病对患者生活质量的影响，尽管确切的机制需要进一步研究。
