Department of Family Medicine, Everan Hospital, Taichung 411001, Taiwan.
Institute of Public Health, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan.
Int J Environ Res Public Health. 2022 Jun 6;19(11):6922. doi: 10.3390/ijerph19116922.
Depression and related syndromes are well identified in older adults. Depression has been reported to increase the incidence of a multitude of somatic disorders. In older adults, the severity of depression is associated with higher mortality rates. The aim of the study is to examine whether the effect of depression screening on mortality is different between individuals with different physical health status. In order to meet this aim, we will first reprove the relationship between depression and mortality rate, and then we will set a subgroup analysis by using self-reported health (SRH) status. Our data source, Taiwan Longitudinal Study on Aging (TLSA), is a population-based prospective cohort study that was initiated by the Health Promotion Administration, Ministry of Health and Welfare, Taiwan. The depression risk was evaluated by 10-items Center for Epidemiologic Studies Depression (CES-D-10), we set 3 CES-D-10 cutting points (5, 10, and 12) and cut our subjects into four groups. Taking mortality as an end point, we use the Taiwan National Death Registry (TNDR) record from 1999 to 2012. Self-rated health (SRH) was taken as an effect modifier between depression and mortality in the elderly group, and stratification took place into three groups (good, fair, poor). The case numbers of 4 CES-D-10 groups were 2253, 939, 285 and 522, respectively. After dividing into 4 CES-D-10 groups, the mortality prevalence rose as the CES-D-10 level grew (40.7%, 47.82%, 54.39% and 67.62%, respectively). In the subgroup analysis, although the p-value of log-rank test showed <0.05 in three groups, as the SRH got worse the Hazard Ratio became more significant (p = 0.122, 0.033, <0.001, respectively). Kaplan−Meier (K-M) survival estimates for different CES-D groups in SRH were poor, and we can see the curves representing second and third CES-D group going almost together, which may suggest the cutting point of CES-D-10 in predicting depression risk should be adjusted in the relatively unhealthy elderly. The importance of the relationship between depression and mortality is re-emphasized in our study. Moreover, through joining SRH in our analysis, we can conclude that in self-rated poor health any sign of depression may lead to a rise in mortality. Therefore, we should pay attention to the old age group’s psychological status, and remember that depressive mood should be scrutinized more carefully in the elderly who feel themselves to be unhealthy.
抑郁及相关综合征在老年人中较为常见。据报道，抑郁会增加多种躯体疾病的发病率。在老年人中，抑郁的严重程度与更高的死亡率相关。本研究旨在探讨抑郁筛查对死亡率的影响是否因个体的身体健康状况不同而不同。为了达到这一目的，我们将首先重新验证抑郁与死亡率之间的关系，然后使用自我报告的健康状况（SRH）进行亚组分析。我们的数据来源是台湾老年纵向研究（TLSA），这是一项由台湾卫生福利部健康促进署发起的基于人群的前瞻性队列研究。抑郁风险由 10 项流行病学研究中心抑郁量表（CES-D-10）评估，我们设定了 3 个 CES-D-10 切点（5、10 和 12），并将研究对象分为四组。以死亡率为终点，我们使用了 1999 年至 2012 年的台湾国家死亡登记处（TNDR）记录。在老年人群中，自我报告的健康状况（SRH）被视为抑郁与死亡率之间的中介因素，并分为三组（良好、一般和较差）。4 个 CES-D-10 组的病例数分别为 2253、939、285 和 522。分为 4 个 CES-D-10 组后，随着 CES-D-10 水平的升高，死亡率的患病率也随之升高（分别为 40.7%、47.82%、54.39%和 67.62%）。在亚组分析中，尽管三组的对数秩检验 p 值均<0.05，但随着 SRH 状况的恶化，风险比变得更加显著（p=0.122、0.033、<0.001）。不同 CES-D 组的 SRH 的 Kaplan-Meier（K-M）生存估计值较差，我们可以看到代表第二和第三 CES-D 组的曲线几乎重合，这可能表明 CES-D-10 预测抑郁风险的切点应在相对不健康的老年人中进行调整。本研究再次强调了抑郁与死亡率之间关系的重要性。此外，通过将 SRH 纳入我们的分析，我们可以得出结论，在自我报告的健康状况较差的情况下，任何抑郁迹象都可能导致死亡率上升。因此，我们应该关注老年人群的心理状态，并记住在自我感觉不健康的老年人中，应更仔细地检查抑郁情绪。
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