Zainal Nur Hani, Newman Michelle G
Department of Psychology, The Pennsylvania State University, University Park, PA16802, USA.
Psychol Med. 2021 Mar 3:1-11. doi: 10.1017/S0033291721000398.
Scar models posit that heightened anxiety and depression can increase the risk for subsequent reduced executive function (EF) through increased inflammation across months. However, the majority of past research on this subject used cross-sectional designs. We therefore examined if elevated generalized anxiety disorder (GAD), major depressive disorder (MDD), and panic disorder (PD) symptoms forecasted lower EF after 20 months through heightened inflammation.
Community-dwelling adults partook in this study (n = 614; MAGE = 51.80 years, 50% females). Time 1 (T1) symptom severity (Composite International Diagnostic Interview - Short Form), T2 (2 months after T1) inflammation serum levels (C-reactive protein, fibrinogen, interleukin-6), and T3 (20 months after T1) EF (Brief Test of Adult Cognition by Telephone) were assessed. Structural equation mediation modeling was performed.
Greater T1 MDD and GAD (but not PD) severity predicted increased T2 inflammation (Cohen's d = 0.21-1.92). Moreover, heightened T2 inflammation forecasted lower T3 EF (d = -1.98 to -1.87). T2 inflammation explained 25-32% of the negative relations between T1 MDD or GAD and T3 EF. T1 GAD severity predicting T3 EF via T2 inflammation path was stronger among younger (v. older) adults. Direct effects of T1 MDD, GAD, and PD forecasting decreased T3 EF were found (d = -2.02 to -1.92). Results remained when controlling for socio-demographic, physical health, and lifestyle factors.
Inflammation can function as a mechanism of the T1 MDD or GAD-T3 EF associations. Interventions that successfully treat depression, anxiety, and inflammation-linked disorders may avert EF decrements.
创伤模型认为，数月间焦虑和抑郁加剧会通过炎症增加，进而提高后续执行功能（EF）降低的风险。然而，过去关于该主题的大多数研究采用的是横断面设计。因此，我们研究了广泛性焦虑症（GAD）、重度抑郁症（MDD）和恐慌症（PD）症状升高是否会通过炎症加剧在20个月后预测较低的EF。
参与本研究的为社区居住成年人（n = 614；平均年龄 = 51.80岁，50%为女性）。评估了时间1（T1）的症状严重程度（综合国际诊断访谈 - 简表）、时间2（T1后2个月）的炎症血清水平（C反应蛋白、纤维蛋白原、白细胞介素 - 6）和时间3（T1后20个月）的EF（成人电话认知简短测试）。进行了结构方程中介模型分析。
更高的T1期MDD和GAD（而非PD）严重程度预测T2期炎症增加（科恩d值 = 0.21 - 1.92）。此外，T2期炎症加剧预测T3期EF较低（d值 = -1.98至 -1.87）。T2期炎症解释了T1期MDD或GAD与T3期EF之间25% - 32%的负相关关系。在年轻（相对于年长）成年人中，T1期GAD严重程度通过T2期炎症路径预测T3期EF的作用更强。发现T1期MDD、GAD和PD预测T3期EF降低的直接效应（d值 = -2.02至 -1.92）。在控制社会人口统计学、身体健康和生活方式因素后，结果依然成立。
炎症可作为T1期MDD或GAD与T3期EF关联的一种机制。成功治疗抑郁症、焦虑症和炎症相关疾病的干预措施可能避免EF下降。
