Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.
Tianjin Key Laboratory of Environment, Nutrition and Public Health, Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China.
Eur Psychiatry. 2022 Oct 3;65(1):e63. doi: 10.1192/j.eurpsy.2022.34.
The differential impact of depression across different periods in life on mortality remains inconclusive. We aimed to examine the association of depression that occurs at different age with all-cause mortality, and to explore the roles of dementia, as well as genetic and early-life environmental factors, in this association.
From the Swedish Twin Registry, 44,919 twin individuals were followed for up to 18 years. Depression was ascertained using the National Patient Registry and categorized as early-life (<45 years), midlife (45-64 years), and late-life (≥65 years) depression according to the age of the first diagnosis. Deaths were identified through the Cause of Death Register. Generalized estimating equation, generalized structural equation, and conditional logistic regression were used for unmatched, mediation, and co-twin matched analyses, respectively.
In unmatched analyses, the multivariate-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of mortality were 1.71 (1.46-2.00) for depression at any age, 1.72 (1.36-2.17) for early-life, 1.51 (1.19-1.90) for midlife, and 4.10 (2.02-8.34) for late-life depression. Mortality was significantly higher in individuals with late-life depression than those with earlier-life depression ( < 0.05). The mediation analysis showed that 59.83% of the depression-mortality association was mediated by dementia. No significant difference in ORs between the unmatched and co-twin matched analyses was observed ( = 0.09).
Depression is associated with an increased risk of all-cause mortality, and dementia mediates approximately 60% of the impact of depression on mortality in late life. Genetic and early-life environmental factors may not play a significant role in the depression-mortality association.
抑郁症在人生不同阶段对死亡率的影响尚不确定。本研究旨在探讨不同年龄段发生的抑郁症与全因死亡率之间的关系，并探讨痴呆症以及遗传和早期环境因素在这种关联中的作用。
从瑞典双胞胎登记处中，对 44919 对双胞胎个体进行了长达 18 年的随访。使用国家患者登记处来确定抑郁症，并根据首次诊断的年龄将其分为早发性（<45 岁）、中年（45-64 岁）和晚发性（≥65 岁）抑郁症。通过死因登记处来确定死亡情况。分别使用广义估计方程、广义结构方程和条件逻辑回归进行非匹配、中介和同卵双胞胎匹配分析。
在非匹配分析中，调整后的多变量比值比（ORs）和 95%置信区间（CIs）分别为：任何年龄段的抑郁症为 1.71（1.46-2.00），早发性为 1.72（1.36-2.17），中年为 1.51（1.19-1.90），晚发性为 4.10（2.02-8.34）。与早发性抑郁症相比，晚发性抑郁症患者的死亡率明显更高（<0.05）。中介分析表明，抑郁症-死亡率关联中有 59.83%是由痴呆症介导的。非匹配和同卵双胞胎匹配分析的 OR 之间没有显著差异（=0.09）。
抑郁症与全因死亡率增加相关，痴呆症大约解释了 60%的抑郁症对晚年死亡率的影响。遗传和早期环境因素可能在抑郁症与死亡率的关联中不起重要作用。
