Wicke F S, Ernst M, Otten D, Werner A, Dreier M, Brähler E, Tibubos A N, Reiner I, Michal M, Wiltink J, Münzel T, Lackner K J, Pfeiffer N, König J, Wild P S, Beutel M E
Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, Mainz 55113, Germany.
Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, Mainz 55113, Germany.
J Affect Disord. 2022 Apr 15;303:315-322. doi: 10.1016/j.jad.2022.02.034. Epub 2022 Feb 15.
The association of depression with mortality and the significance of explanatory factors, in particularly gender, have remained an issue of debate. We therefore aimed to estimate the effect of depression on all-cause mortality, to examine potential explanatory factors and to assess effect modification by gender.
We used Cox regression models to estimate the effect of depression on mortality based on data from the Gutenberg Health Study, which is a prospective cohort study of the adult population in the districts of Mainz and Mainz-Bingen, Germany. Baseline assessment was between 2007 and 2012. Effect modification by gender was measured on both additive and multiplicative scales.
Out of 14,653 participants, 7.7% were depressed according to Patient Health Questionnaire 9 (PHQ-9), and 1,059 (7.2%) died during a median follow-up of 10.7 years. Depression elevated the risk of mortality in men and women in age-adjusted models (HR: 1.41, 95%-CI: 1.03-1.92; resp. HR: 1.96, 95%-CI: 1.43-2.69). Adjustment for social status, physical health and lifestyle covariates attenuated the effect and in the fully-adjusted model the hazard ratio was 0.96 (95%-CI: 0.69-1.33) in men and 1.53 (95%-CI: 1.10-2.12) in women. For effect modification by gender, the measure on multiplicative interaction was 0.68 (95%-CI 0.44-1.07) and on additive interaction was RERI=-0.47 (95%-CI -1.24-0.30).
The PHQ-9 is a single self-report measure of depression reflecting symptoms of the past two weeks, limiting a more detailed assessment of depression and course of symptoms, which likely affects the association with mortality.
Depression elevates mortality by multifactorial pathways, which should be taken into account in the biopsychosocially informed treatment of depression. Effect modification by gender was not statistically significant.
抑郁症与死亡率之间的关联以及解释因素（尤其是性别）的重要性一直是一个有争议的问题。因此，我们旨在评估抑郁症对全因死亡率的影响，研究潜在的解释因素，并评估性别对效应的修正作用。
我们使用Cox回归模型，基于古登堡健康研究的数据来评估抑郁症对死亡率的影响。该研究是一项针对德国美因茨和美因茨 - 宾根地区成年人口的前瞻性队列研究。基线评估在2007年至2012年之间进行。通过相加和相乘尺度来衡量性别对效应的修正作用。
在14,653名参与者中，根据患者健康问卷9（PHQ - 9），7.7%的人患有抑郁症，在中位随访10.7年期间，1,059人（7.2%）死亡。在年龄调整模型中，抑郁症增加了男性和女性的死亡风险（风险比：1.41，95%置信区间：1.03 - 1.92；相应地，风险比：1.96，95%置信区间：1.43 - 2.69）。对社会地位、身体健康和生活方式协变量进行调整后，效应有所减弱，在完全调整模型中，男性的风险比为0.96（95%置信区间：0.69 - 1.33），女性为1.53（95%置信区间：1.10 - 2.12）。对于性别对效应的修正作用，相乘交互作用的测量值为0.68（95%置信区间0.44 - 1.07），相加交互作用的相对额外危险度（RERI）为 - 0.47（95%置信区间 - 1.24 - 0.30）。
PHQ - 9是一种单一的自我报告抑郁症测量方法，反映过去两周的症状，限制了对抑郁症及其症状过程的更详细评估，这可能会影响与死亡率的关联。
抑郁症通过多因素途径提高死亡率，在抑郁症的生物心理社会综合治疗中应予以考虑。性别对效应的修正作用在统计学上不显著。
