Department of Psychology and Neuroscience, Duke University, Durham, North Carolina.
Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.
JAMA Psychiatry. 2021 May 1;78(5):530-539. doi: 10.1001/jamapsychiatry.2020.4626.
Individuals with mental disorders are at an elevated risk of developing chronic age-related physical diseases. However, it is not clear whether psychopathology is also associated with processes of accelerated aging that precede the onset of age-related disease.
To test the hypothesis that a history of psychopathology is associated with indicators of accelerated aging at midlife.
DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study was based on the Dunedin Multidisciplinary Health and Development Study, a population-representative birth cohort of 1037 individuals born between April 1, 1972, and March 31, 1973, in Dunedin, New Zealand. Members were followed up to age 45 years (until April 2019). Data were analyzed from January 6 to December 7, 2020.
Mental disorders were assessed in 6 diagnostic assessments from ages 18 to 45 years and transformed through confirmatory factor analysis into continuous measures of general psychopathology (p-factor) and dimensions of internalizing, externalizing, and thought disorders (all standardized to a mean [SD] of 100 [15]).
Signs of aging (biological pace of aging; declines in sensory, motor, and cognitive functioning; and facial age) were assessed up to age 45 years using previously validated measures including biomarkers, clinical tests, and self-reports.
Of the original 1037 cohort participants, 997 were still alive at age 45 years, of whom 938 (94%) were assessed (474 men [50.5%]). Participants who had experienced more psychopathology exhibited a faster pace of biological aging (β, 0.27; 95% CI, 0.21-0.33; P < .01); experienced more difficulties with hearing (β, 0.18; 95% CI, 0.12-0.24; P < .01), vision (β, 0.08; 95% CI, 0.01-0.14; P < .05), balance (β, 0.20; 95% CI, 0.14-0.26; P < .01), and motor functioning (β, 0.19; 95% CI, 0.12-0.25; P < .01); experienced more cognitive difficulties (β, 0.24; 95% CI, 0.18-0.31; P < .01); and were rated as looking older (β, 0.20; 95% CI, 0.14-0.26; P < .01). Associations persisted after controlling for sex, childhood health indicators, maltreatment, and socioeconomic status and after taking into account being overweight, smoking, use of antipsychotic medication, and the presence of physical disease. Tests of diagnostic specificity revealed that associations were generalizable across externalizing, internalizing, and thought disorders.
In this cohort study, a history of psychopathology was associated with accelerated aging at midlife, years before the typical onset of age-related diseases. This link is not specific to any particular disorder family but generalizes across disorders. Prevention of psychopathology and monitoring of individuals with mental disorders for signs of accelerated aging may have the potential to reduce health inequalities and extend healthy lives.
精神障碍患者罹患慢性与年龄相关的躯体疾病的风险较高。然而，目前尚不清楚精神病理学是否与年龄相关疾病发病前的加速衰老过程有关。
检验既往精神病史与中年时期加速衰老标志物相关的假设。
设计、地点和参与者：本前瞻性队列研究基于 Dunedin 多学科健康与发展研究，这是一项在新西兰达尼丁进行的具有代表性的出生队列研究，共纳入了 1972 年 4 月 1 日至 1973 年 3 月 31 日期间出生的 1037 名个体。参与者随访至 45 岁（截至 2019 年 4 月）。数据分析于 2020 年 1 月 6 日至 12 月 7 日进行。
18 岁至 45 岁期间采用 6 次诊断评估来评估精神障碍，并通过验证性因素分析将其转化为一般精神病理学的连续度量（p 因子）和内化、外化和思维障碍的维度（均标准化为 100 [15]的平均值 [标准差]）。
采用之前验证过的测量方法（包括生物标志物、临床检查和自我报告），在 45 岁之前评估衰老迹象（生物学衰老速度；感觉、运动和认知功能下降；以及面部年龄）。
在最初的 1037 名队列参与者中，997 人在 45 岁时仍然存活，其中 938 人（94%）接受了评估（474 名男性[50.5%]）。经历更多精神病理学的参与者表现出更快的生物学衰老速度（β，0.27；95%CI，0.21-0.33；P <.01）；听力（β，0.18；95%CI，0.12-0.24；P <.01）、视力（β，0.08；95%CI，0.01-0.14；P <.05）、平衡（β，0.20；95%CI，0.14-0.26；P <.01）和运动功能（β，0.19；95%CI，0.12-0.25；P <.01）障碍更明显；认知困难更大（β，0.24；95%CI，0.18-0.31；P <.01）；并且看起来更老（β，0.20；95%CI，0.14-0.26；P <.01）。在控制性别、儿童健康指标、虐待和社会经济地位后，并且考虑到超重、吸烟、使用抗精神病药物和存在躯体疾病后，这些关联仍然存在。诊断特异性检验表明，这些关联在外化、内化和思维障碍中具有普遍性。
在这项队列研究中，既往精神病史与中年时期的加速衰老有关，这发生在与年龄相关疾病的典型发病之前数年。这种联系不仅限于任何特定的障碍家族，而是具有普遍性。预防精神障碍以及监测精神障碍患者的加速衰老迹象，可能有助于减少健康不平等现象并延长健康寿命。
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