Suradom Chawisa, Wongpakaran Nahathai, Wongpakaran Tinakon, Lerttrakarnnon Peerasak, Jiraniramai Surin, Taemeeyapradit Unchulee, Lertkachatarn Surang, Arunpongpaisal Suwanna, Kuntawong Pimolpun
Geriatric Psychiatry Unit, Department of Psychiatry, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Rd., Chiang Mai, 50200, Thailand.
Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Ann Gen Psychiatry. 2020 Nov 17;19(1):63. doi: 10.1186/s12991-020-00313-3.
A number of studies have been conducted on risk factors of comorbid anxiety disorders regarding late-life depression (LLD). This study investigated the associated factors and their relationship to comorbid anxiety disorders in LLD.
Participants included 190 elderly Thais (73.2% female, with a mean age of 68.39 ± 6.74 years) with depressive disorders, diagnosed according to DSM-IV Diagnosis Axis I disorders assessed by Mini-International Neuropsychiatric Interview. Demographic data, medical and psychiatric history, family psychiatric history, past depression, family history of depression, Neuroticism Inventory and 7-Item Hamilton Depression Rating Scale (HAMD-7) were analyzed for path analysis using Structural Equation Model framework. The bootstrapping method was used for testing indirect effects.
Being female was associated with comorbid anxiety disorders with an indirect effect (β = - 0.032, P = 0.018) through neuroticism, depression severity, history and family history of depression. Family history of depression had no effect on comorbidity (P = 0.090). Neuroticism had an indirect effect on comorbid anxiety disorders (β = 0.075, P = 0.019) via depression severity as reflected by HAMD-7 score (β = 0.412, P = < 0.001). Total variance explained from this model was 11%. This model had good-fit index with Chi-square > 0.05, CFI and TLI > 0.95 and RMSEA < 0.06.
Neuroticism mediates the effect of relationship between sex, family history and history of depressive disorders and comorbid anxiety disorders in LLD. Moreover, depression severity is a mediator for neuroticism and comorbid anxiety disorders. Longitudinal studies are warranted to indicate the importance of effective treatment of depression to lower the risk of developing comorbid anxiety disorders among depressed elderly.
针对老年期抑郁症（LLD）共病焦虑症的危险因素已开展了多项研究。本研究调查了LLD中共病焦虑症的相关因素及其相互关系。
研究对象包括190名患有抑郁症的泰国老年人（女性占73.2%，平均年龄68.39±6.74岁），根据通过迷你国际神经精神访谈评估的DSM-IV诊断轴I障碍进行诊断。使用结构方程模型框架对人口统计学数据、医学和精神病史、家族精神病史、既往抑郁症、抑郁症家族史、神经质量表和7项汉密尔顿抑郁量表（HAMD-7）进行路径分析。采用自抽样法检验间接效应。
女性与共病焦虑症相关，通过神经质、抑郁严重程度、抑郁症病史和家族史产生间接效应（β = -0.032，P = 0.018）。抑郁症家族史对共病无影响（P = 0.090）。神经质通过HAMD-7评分所反映的抑郁严重程度对共病焦虑症产生间接效应（β = 0.075，P = 0.019）（β = 0.412，P < 0.001）。该模型解释的总方差为11%。该模型具有良好的拟合指数：卡方>0.05，CFI和TLI>0.95，RMSEA<0.06。
神经质介导了LLD中性别、家族史和抑郁症病史与共病焦虑症之间关系的影响。此外，抑郁严重程度是神经质和共病焦虑症之间的中介因素。有必要开展纵向研究以表明有效治疗抑郁症对降低老年抑郁症患者发生共病焦虑症风险的重要性。
