抑郁症状的纵向轨迹：共病、移动性和主观记忆的作用。
Longitudinal trajectories of depressive symptoms: the role of multimorbidity, mobility and subjective memory.
机构信息
Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China.
Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, 250000, Shandong, China.
出版信息
BMC Geriatr. 2023 Jan 12;23(1):22. doi: 10.1186/s12877-023-03733-4.
BACKGROUND
The high prevalence of depression among older people in China places a heavy burden on the health system. Multimorbidity, mobility limitation and subjective memory impairment are found to be risk indicators for depression. However, most studies on this topic focused on depression at a single point in time, ignoring the dynamic changes in depressive symptoms and the relationship between the trajectories and these three conditions. Therefore, we aimed to identify distinct trajectories of depressive symptoms in older people and investigate their associations with multimorbidity, mobility limitation and subjective memory impairment.
METHODS
Data was drawn from China Health and Retirement Longitudinal Study conducted during 2011-2018. A total of 5196 participants who completed 4 visits, conducted every 2-3 years were included in this study. Group-based trajectory modeling was conducted to identify distinct trajectories of depressive symptoms z-scores. Multinomial logistic regression was used to investigate the relationships.
RESULTS
Four distinct trajectories of depressive symptoms z-scores were identified, labeled as persistently low symptoms (68.69%, n = 3569), increasing symptoms (12.14%, n = 631), decreasing symptoms (14.05%, n = 730) and persistently high symptoms (5.12%, n = 266). Participants with multimorbidity had unfavorable trajectories of depressive symptoms compared with those without multimorbidity, with adjusted odds ratios (95% CIs) of 1.40 (1.15, 1.70), 1.59 (1.33, 1.90) and 2.19 (1.65, 2.90) for the increasing symptoms, decreasing symptoms and persistently high symptoms, respectively. We also observed a similar trend among participants with mobility limitations. Compared with participants who had poor subjective memory, participants with excellent/very good/good subjective memory had a lower risk of developing unfavorable trajectories of depressive symptoms. The adjusted odds ratios (95% CIs) of the increasing symptoms, decreasing symptoms and persistently high symptoms were 0.54 (0.40, 0.72), 0.50 (0.38, 0.65) and 0.48 (0.31, 0.73), respectively.
CONCLUSIONS
Multimorbidity, mobility limitation and subjective memory impairment were found to be potential risk factors for unfavorable depression trajectories.
背景
中国老年人中抑郁症的高患病率给医疗系统带来了沉重的负担。研究发现，多病共存、行动受限和主观记忆障碍是抑郁的风险指标。然而，大多数关于这一主题的研究都集中在某一时刻的抑郁，忽略了抑郁症状的动态变化以及这些情况与轨迹之间的关系。因此，我们旨在确定老年人抑郁症状的不同轨迹，并研究它们与多病共存、行动受限和主观记忆障碍的关系。
方法
数据来自于 2011-2018 年期间开展的中国健康与养老追踪调查。本研究共纳入了 5196 名完成了 4 次随访（每 2-3 年进行一次）的参与者。采用基于群组的轨迹建模来识别抑郁症状 z 分数的不同轨迹。采用多变量逻辑回归来研究它们之间的关系。
结果
确定了 4 种不同的抑郁症状 z 分数轨迹，分别命名为持续低度症状（68.69%，n=3569）、症状增加（12.14%，n=631）、症状减少（14.05%，n=730）和持续高度症状（5.12%，n=266）。与无多病共存的参与者相比，多病共存的参与者有不利的抑郁症状轨迹，调整后的比值比（95%置信区间）分别为 1.40（1.15，1.70）、1.59（1.33，1.90）和 2.19（1.65，2.90）。我们还观察到行动受限参与者中也存在类似的趋势。与主观记忆较差的参与者相比，主观记忆优秀/非常好/好的参与者出现不利的抑郁症状轨迹的风险较低。调整后的比值比（95%置信区间）分别为症状增加、症状减少和持续高度症状的 0.54（0.40，0.72）、0.50（0.38，0.65）和 0.48（0.31，0.73）。
结论
多病共存、行动受限和主观记忆障碍被认为是不利抑郁轨迹的潜在风险因素。
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