适度饮酒与抑郁症：一种促进因果推断的边际结构模型方法

Moderate Alcohol Consumption and Depression: A Marginal Structural Model Approach Promoting Causal Inference.

作者信息

Visontay Rachel, Mewton Louise, Slade Tim, Aris Izzuddin M, Sunderland Matthew

机构信息

Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, Australia (Visontay, Mewton, Slade, Sunderland); Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Mewton); Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Aris).

出版信息

Am J Psychiatry. 2023 Mar 1;180(3):209-217. doi: 10.1176/appi.ajp.22010043. Epub 2023 Jan 18.

DOI:10.1176/appi.ajp.22010043

PMID:36651625

Abstract

OBJECTIVE

Moderate alcohol consumption is associated with decreased risk for depression, but it remains unclear whether this is a causal relationship or a methodological artifact. To compare the effects of consistent abstinence and occasional, moderate, and above-guideline alcohol consumption throughout early to middle adulthood on depression at age 50, the authors conducted a secondary analysis of the National Longitudinal Survey of Youth 1979 cohort and employed a marginal structural model (MSM) approach.

METHODS

Baseline was set at 1994, when individuals were ages 29-37. The MSM incorporated measurements of alcohol consumption in 1994, 2002, and 2006, baseline and time-varying covariates, and repeated measurements with the Center for Epidemiologic Studies Depression Scale-Short Form (CES-D-SF). A total of 5,667 eligible participants provided valid data at baseline, 3,593 of whom provided valid outcome data. The authors used all observed data to predict CES-D-SF means and rates of probable depression for hypothetical trajectories of consistent alcohol consumption.

RESULTS

The results approximated J-curve relationships. Specifically, both consistent occasional and consistent moderate drinkers were predicted to have reduced CES-D-SF scores and rates of probable depression at age 50 compared with consistent abstainers (CES-D-SF scores: b=-0.84, 95% CI=-1.47, -0.11; probable depression: odds ratio=0.58, 95% CI=0.36, 0.88 for consistent occasional drinkers vs. abstainers; CES-D-SF scores: b=-1.08, 95% CI=-1.88, -0.20; probable depression: odds ratio=0.59, 95% CI=0.26, 1.13 for consistent moderate drinkers vs. consistent abstainers). Consistent above-guideline drinkers were predicted to have slightly increased risk compared with consistent abstainers, but this was not significant. In sex-stratified analyses, results were similar for females and males.

CONCLUSIONS

This study contributes preliminary evidence that associations between moderate alcohol consumption and reduced risk for depression may reflect genuine causal effects. Further research using diverse methodologies that promote causal inference is required.

摘要

目的

适度饮酒与抑郁症风险降低有关，但这是因果关系还是方法学假象仍不清楚。为了比较从成年早期到中年期持续戒酒以及偶尔、适度和超过指南建议饮酒对50岁时抑郁症的影响，作者对1979年全国青年纵向调查队列进行了二次分析，并采用了边际结构模型（MSM）方法。

方法

基线设定为1994年，当时个体年龄在29 - 37岁。MSM纳入了1994年、2002年和2006年的饮酒量测量、基线和随时间变化的协变量，以及使用流行病学研究中心抑郁量表简表（CES - D - SF）进行的重复测量。共有5667名符合条件的参与者在基线时提供了有效数据，其中3593人提供了有效的结局数据。作者使用所有观察到的数据来预测持续饮酒假设轨迹的CES - D - SF均值和可能患抑郁症的比率。

结果

结果近似于J曲线关系。具体而言，预计持续偶尔饮酒者和持续适度饮酒者在50岁时的CES - D - SF得分和可能患抑郁症的比率均低于持续戒酒者（CES - D - SF得分：b = - 0.84，95%置信区间 = - 1.47， - 0.11；可能患抑郁症：持续偶尔饮酒者与戒酒者相比，优势比 = 0.58，95%置信区间 = 0.36，0.88；CES - D - SF得分：b = - 1.08，95%置信区间 = - 1.88， - 0.20；可能患抑郁症：持续适度饮酒者与持续戒酒者相比，优势比 = 0.59，95%置信区间 = 0.26，1.13）。预计持续超过指南建议饮酒者与持续戒酒者相比风险略有增加，但不显著。在按性别分层的分析中，女性和男性的结果相似。