State Key Laboratory of Kidney Disease, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Institute of Geriatrics, The 2nd Medical Center of Chinese PLA General Hospital, Beijing, China.
Department of Disease Prevention and Control, The 1st Medical Center, Chinese PLA General Hospital, Beijing, China.
Front Public Health. 2020 Oct 30;8:580757. doi: 10.3389/fpubh.2020.580757. eCollection 2020.
As evidence on depression and health-related quality of life (HRQoL) among the oldest-old is currently limited, this study aimed to re-examine the association between depression and HRQoL among centenarians. We analyzed cross-sectional data from the China Hainan Centenarian Cohort Study (CHCCS). The 15-item Geriatric Depression Scale (GDS-15) and three-level EuroQol five-dimensions (EQ-5D-3L) were used to evaluate depression and HRQoL, respectively. Poor health states were defined as EQ-5D index <0.665. Based on their GDS-15 score, individuals were categorized into three stages of depression: major depressive disorder (MDD; score ≥10), minor depressive disorder (MnDD; score between 6 and 9), and normal (score ≤ 5). Based on sex and comorbidity stratification, multivariable logistic regression was used to calculate the risk of poor health state in different levels of depression. We also used restricted cubic splines with a knot at 5 points (GDS-15) to flexibly model the association of GDS-15 scores with poor health states. Totally, 1,002 participants were included in this study for analysis. Participants' median age was 102 years, and 82.04% were female. The median EQ-5D index was 0.68 (range: -0.149-1), and the mean VAS and GDS-15 scores were 61.60 (range: 0-100), and 5.23 (range: 0-15), respectively. Centenarians with MnDD and MDD accounted for 38.12 and 9.98%, respectively. While those with poor health states accounted for 45.11%. For every 1-point increase in GDS-15, the risk of poor health state increased by 20% ( < 0.001) after an adjustment for age, gender, ethnicity, marital status, education, residence type, smoking, drinking, weekly exercise, body mass index category, serum albumin, 25-hydroxyvitamin D, C-reactive protein, and comorbidities. MnDD and MDD were independent risk factors for poor health state (MnDD, OR = 2.76, < 0.001; MDD, OR = 3.14, < 0.001). The association was more prominent in centenarians without comorbidity. This study demonstrated a negative association between depression and HRQoL in Chinese centenarians, especially in centenarians without comorbidity. Large-scale prospective studies are needed to corroborate our findings and provide more information about the causal inference and internal mechanisms of this association.
随着目前关于最年长人群中抑郁和健康相关生活质量（HRQoL）的证据有限，本研究旨在重新检验百岁老人中抑郁与 HRQoL 之间的关联。我们分析了中国海南百岁老人队列研究（CHCCS）的横断面数据。使用 15 项老年抑郁量表（GDS-15）和三级欧洲五维健康量表（EQ-5D-3L）分别评估抑郁和 HRQoL。健康状况不佳定义为 EQ-5D 指数 <0.665。根据他们的 GDS-15 评分，个体被分为三个抑郁阶段：重度抑郁障碍（MDD；得分≥10）、轻度抑郁障碍（MnDD；得分在 6 到 9 之间）和正常（得分≤5）。基于性别和合并症分层，多变量逻辑回归用于计算不同抑郁水平下健康状况不佳的风险。我们还使用了带有 5 个节点的限制立方样条（GDS-15）来灵活地构建 GDS-15 评分与健康状况不佳之间的关联。共有 1002 名参与者纳入本研究进行分析。参与者的中位年龄为 102 岁，82.04%为女性。中位 EQ-5D 指数为 0.68（范围：-0.149-1），平均 VAS 和 GDS-15 评分分别为 61.60（范围：0-100）和 5.23（范围：0-15）。MnDD 和 MDD 分别占 38.12%和 9.98%。而健康状况不佳的比例为 45.11%。GDS-15 每增加 1 分，在调整年龄、性别、种族、婚姻状况、教育程度、居住类型、吸烟、饮酒、每周运动、体重指数类别、血清白蛋白、25-羟维生素 D、C 反应蛋白和合并症后，健康状况不佳的风险增加 20%（<0.001）。MnDD 和 MDD 是健康状况不佳的独立危险因素（MnDD，OR=2.76，<0.001；MDD，OR=3.14，<0.001）。在没有合并症的百岁老人中，这种关联更为明显。本研究表明，抑郁与中国百岁老人的 HRQoL 呈负相关，尤其是在没有合并症的百岁老人中。需要进行大规模前瞻性研究来证实我们的发现，并提供更多关于这种关联的因果推断和内在机制的信息。
