Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry and GGZ inGeest, Amsterdam Public Health Research Institute, the Netherlands.
Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry and GGZ inGeest, Amsterdam Public Health Research Institute, the Netherlands.
J Psychosom Res. 2020 Jun;133:109996. doi: 10.1016/j.jpsychores.2020.109996. Epub 2020 Mar 14.
The observed poorer physical function in persons with mental disorders could partly be due to dysregulation in physiological stress systems. However, an integrated picture of the role of physiological stress systems on objective physical function is lacking. This study examined the association of multiple physiological stress systems with objective physical function, and explored whether these stress systems contribute to the relationship between depression/anxiety and poorer physical function.
Data of 2860 persons of the Netherlands Study of Depression and Anxiety was used. Physical function was indicated by hand grip strength assessed using a hand-held dynamometer and lung function assessed using a peak flow meter. Inflammatory markers (CRP, IL-6, TNF-α), salivary cortisol (cortisol awakening response (AUCg, AUCi), evening cortisol) and ANS markers (heartrate, PEP, RSA) were determined. Depression/anxiety disorders were determined using psychiatric interviews. Linear regression analyses were adjusted for sociodemographics, health and lifestyle factors.
Higher inflammation levels were associated with lower hand grip strength (B = -0.21(SE = 0.06), p < .001) and lower lung function (B = -2.07(SE = 0.66), p = .002), B = -3.35(SE = 1.42), p = .022). Higher salivary cortisol levels were associated with lower lung function (B = -2.22(SE = 0.59), p < .001). The association, in women, between depression/anxiety disorders and poorer physical function did not significantly diminish after adjustment for physiological stress markers.
This large cohort study showed that stress system dysfunction (especially the immune-inflammatory system and HPA-axis) contributes to poorer objective physical function. Stress system dysfunction did not explain the poorer physical function observed in persons with depression/anxiety disorders, suggesting that other pathways are involved to explain that association.
精神障碍患者的身体机能较差，这在一定程度上可能是由于生理应激系统失调所致。然而，生理应激系统对客观身体机能的综合影响尚不清楚。本研究旨在探讨多种生理应激系统与客观身体机能的关系，并探讨这些应激系统是否有助于解释抑郁/焦虑与较差身体机能之间的关系。
本研究使用了荷兰抑郁与焦虑研究（NESDA）的数据，共纳入了 2860 名研究对象。使用手持测力计评估握力，使用峰值流量计评估肺功能，以此来表示身体机能。采用酶联免疫吸附法（ELISA）测定炎症标志物（CRP、IL-6、TNF-α），唾液皮质醇（皮质醇觉醒反应（AUCg、AUCi）、傍晚皮质醇）和自主神经系统（ANS）标志物（心率、PEP、RSA）。使用精神科访谈确定抑郁/焦虑障碍。线性回归分析调整了社会人口统计学、健康和生活方式因素。
更高的炎症水平与较低的握力（B = -0.21（SE = 0.06），p <.001）和较低的肺功能（B = -2.07（SE = 0.66），p =.002）、B = -3.35（SE = 1.42），p =.022）相关。较高的唾液皮质醇水平与较低的肺功能相关（B = -2.22（SE = 0.59），p <.001）。在女性中，抑郁/焦虑障碍与较差的身体机能之间的关联，在调整生理应激标志物后并未显著减弱。
本大型队列研究表明，应激系统功能障碍（特别是免疫炎症系统和 HPA 轴）与较差的客观身体机能有关。应激系统功能障碍并不能解释抑郁/焦虑障碍患者较差的身体机能，这表明其他途径可能参与了解释这种关联。
