Department of Epidemiology and Biostatistics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China.
Department of Food Safety and Toxicology, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China.
J Affect Disord. 2022 Jan 15;297:283-293. doi: 10.1016/j.jad.2021.10.023. Epub 2021 Oct 21.
We investigated the prospective bidirectional association between depressive symptoms and chronic lung disease (CLD) and explored biologically and behaviorally relevant mediators in this bidirectional association among Chinese middle-aged and older population in the China Health and Retirement Longitudinal Study.
Multivariable-adjusted Cox proportional hazard models were used to examine baseline depressive symptoms in relation to incident CLD risk among 12,546 adults and examine CLD condition in association with incidence of elevated depressive symptoms among 6,929 participants from 2011 to 2018. Elevated depressive symptoms were assessed with the 10-item Center for Epidemiologic Studies Depression scale and CLD was determined by self-reported physician diagnosis. Causal mediation analysis was performed to examine the direct and indirect effects of a priori selected nine blood biomarkers and four lifestyle factors in the bidirectional association.
Elevated depressive symptoms significantly increased CLD risk by 68% (HR=1.68, 95%CI=1.46-1.93) after a mean follow-up of 5.9 years and the strong positive association was consistently shown in almost all the subgroups. Having positive CLD status at baseline was associated with 17% increased risk of developing elevated depressive symptoms (HR=1.17, 95%CI=1.01-1.35) during an average of 4.6 years follow-up period. Significant inflammatory, metabolic or pulmonary function related mediators were not identified.
Inadequate follow-up time and limited mediator variable information may reduce chance of identifying significant mediators.
Elevated depressive symptoms and CLD were mutual risk factors in middle-aged and older Chinese adults. Early screening and treatment of depression is needed to reduce CLD risk and related comorbidities including new-onset depression so as to relieve substantial disease burdens of CLD and depression in China.
我们调查了抑郁症状与慢性肺部疾病（CLD）之间的前瞻性双向关联，并在中国健康与退休纵向研究中探索了这一双向关联中具有生物学和行为相关性的中介因素。
使用多变量调整的 Cox 比例风险模型，在 12546 名成年人中检查基线抑郁症状与新发 CLD 风险的关系，并在 2011 年至 2018 年期间，在 6929 名参与者中检查 CLD 状况与升高的抑郁症状发生率的关系。使用 10 项中心流行病学研究抑郁量表评估升高的抑郁症状，通过自我报告的医生诊断确定 CLD。进行因果中介分析，以检验预先选择的 9 种血液生物标志物和 4 种生活方式因素在双向关联中的直接和间接作用。
在平均 5.9 年的随访后，升高的抑郁症状显著增加了 CLD 风险 68%（HR=1.68，95%CI=1.46-1.93），且在几乎所有亚组中均显示出强烈的正相关。在基线时存在阳性 CLD 状态与在平均 4.6 年的随访期间发生升高的抑郁症状的风险增加 17%（HR=1.17，95%CI=1.01-1.35）相关。未发现有显著的炎症、代谢或肺功能相关的中介因素。
随访时间不足和中介变量信息有限，可能会降低识别显著中介因素的机会。
升高的抑郁症状和 CLD 是中国中年及以上成年人的相互危险因素。需要对抑郁症进行早期筛查和治疗，以降低 CLD 风险和相关合并症的发生，包括新发抑郁症，从而减轻中国 CLD 和抑郁症的巨大疾病负担。
