Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, Columbia.
Department of Psychology, University of South Carolina, Columbia.
J Gerontol A Biol Sci Med Sci. 2021 Aug 13;76(9):e171-e178. doi: 10.1093/gerona/glaa253.
The association between depression and fall risk in older adults is recognized, yet the mechanisms underlying this association are unclear. This study estimated the mediating role of antidepressant use in the association between depression and falls and fall injuries.
Longitudinal data from the Health and Retirement Study (2004-2006) were linked with medication data from the Prescription Drug Study (2005). The sample included community-dwelling adults aged ≥65 with data on depression and medication use (n = 3565). Depression was measured using 2 independent survey tools: Composite International Diagnostic Interview for depression short form and an 8-item version of the Center for Epidemiological Studies-Depression scale. We used causal mediation analysis to estimate and compare the direct and indirect (mediated by antidepressant use) effects of depression on falls and fall injuries.
Individuals with major depressive disorder were significantly more likely to experience a fall (OR: 1.92; 95% CI: 1.41, 2.62) and a fall injury (OR: 1.67; 95% CI: 1.09, 2.55) over 2 years. Indirect effect estimates showed that antidepressant medication use accounted for approximately 19% and 18% of the association between major depressive disorder and falls and fall injuries, respectively. Results were similar when using an alternative depression measure and when considering only selective serotonin reuptake inhibitor antidepressants.
Antidepressant use explains a significant proportion, but not a majority, of the association between depression and greater fall risk. Treatment benefits of antidepressants should be considered with, and may outweigh, concerns about increased risk of falls associated with antidepressant use.
老年人抑郁与跌倒风险之间的关联已得到公认，但这种关联的机制尚不清楚。本研究旨在评估抗抑郁药的使用在抑郁与跌倒和跌倒损伤之间的关联中的中介作用。
将健康与退休研究（2004-2006 年）的纵向数据与处方药物研究（2005 年）的药物数据相联系。样本包括有抑郁和药物使用数据的年龄≥65 岁的社区居住成年人（n=3565）。使用 2 种独立的调查工具来衡量抑郁：复合国际诊断访谈抑郁简短形式和流行病学研究中心抑郁量表的 8 项版本。我们使用因果中介分析来估计和比较抑郁对跌倒和跌倒损伤的直接和间接（通过抗抑郁药使用介导）影响。
患有重度抑郁症的个体在 2 年内发生跌倒（OR：1.92；95%CI：1.41，2.62）和跌倒损伤（OR：1.67；95%CI：1.09，2.55）的可能性明显更高。间接效应估计表明，抗抑郁药物的使用分别解释了重度抑郁症与跌倒和跌倒损伤之间关联的约 19%和 18%。当使用替代的抑郁测量方法和仅考虑选择性 5-羟色胺再摄取抑制剂抗抑郁药时，结果是相似的。
抗抑郁药的使用解释了抑郁与更高跌倒风险之间的很大一部分关联，但不是全部关联。应该考虑抗抑郁药物治疗的益处，并且可能超过与抗抑郁药物使用相关的跌倒风险增加的担忧。
