Muhammad T, Pai Manacy, Ansari Salmaan
Department of Family & Generations, International Institute for Population Sciences, Mumbai, India.
Department of Sociology, Kent State University, Kent, OH 44242, USA.
Dialogues Health. 2023 Feb 1;2:100107. doi: 10.1016/j.dialog.2023.100107. eCollection 2023 Dec.
Despite the global disease burden associated with the co-occurrence of cardiovascular diseases (CVDs) and depression, depression remains underdiagnosed and undertreated in the CVD population, especially among older adults in India. As such, this study examines (1) the association between single and multiple CVDs and major depressive disorder among older Indians; (2) whether this association is mediated by older adults' self-rated health and functional limitations; and (3) whether these associations vary for older men and women.
Data come from the 2017-18 wave 1 of the Longitudinal Ageing Study in India. Multivariable logistic regression is used to explore the association between CVDs and major depressive disorder among older men and women. The Karlson-Holm-Breen (KHB) method is used to examine the mediation effects of self-rated health and functional difficulties in the observed associations.
Overall, 5.08% of the older adults had multiple CVDs. Older women (9.71%) had a higher prevalence of major depressive disorder compared to men (7.50%). Multiple CVDs were associated with greater odds of major depressive disorder after adjusting the potential covariates (adjusted odds ratio [AOR]: 1.49; 95% confidence interval [CI]: 1.10-2.00). Older men with multiple CVDs had a greater risk of major depressive disorder (AOR: 1.64; 95% CI: 1.05-2.57) relative to women with CVDs (AOR: 1.39; 95% CI: 0.93-2.08). The association between multiple CVDs and depression was mediated by self-rated health (34.03% for men vs. 34.55% for women), ADL difficulty (22.25% vs. 15.42%), and IADL difficulty (22.90% vs. 19.10%).
One in five older Indians with multiple CVDs reports major depressive disorder, which is three times more common than the prevalence of depressive disorder in older adults without CVDs. This association is attenuated by self-rated health and functional limitations. Moreover, these associations are more pronounced in older men relative to older women. These findings depart from prior inferences that men with CVDs are less psychologically distressed than their female counterparts. Moreover, the findings underscore the importance of gender-specific approaches to interventions and therapeutics for CVD-related mental health.
尽管心血管疾病（CVD）与抑郁症并存会带来全球疾病负担，但在CVD患者群体中，抑郁症仍未得到充分诊断和治疗，尤其是在印度的老年人群体中。因此，本研究调查了：（1）印度老年人中单一和多种CVD与重度抑郁症之间的关联；（2）这种关联是否由老年人的自评健康状况和功能受限所介导；（3）这些关联在老年男性和女性中是否存在差异。
数据来自印度纵向老龄化研究2017 - 18年的第1波调查。多变量逻辑回归用于探究老年男性和女性中CVD与重度抑郁症之间的关联。卡尔森 - 霍尔姆 - 布林（KHB）方法用于检验自评健康状况和功能困难在观察到的关联中的中介作用。
总体而言，5.08%的老年人患有多种CVD。老年女性（9.71%）的重度抑郁症患病率高于男性（7.50%）。在调整潜在协变量后，多种CVD与更高的重度抑郁症患病几率相关（调整后的优势比[AOR]：1.49；95%置信区间[CI]：1.10 - 2.00）。与患有CVD的女性相比（AOR：1.39；95% CI：0.93 - 2.08），患有多种CVD的老年男性患重度抑郁症的风险更高（AOR：1.64；95% CI：1.05 - 2.57）。多种CVD与抑郁症之间的关联由自评健康状况（男性为34.03%，女性为34.55%）、日常生活活动（ADL）困难（22.25%对15.42%）和工具性日常生活活动（IADL）困难（22.90%对19.10%）所介导。
五分之一患有多种CVD的印度老年人报告患有重度抑郁症，这比没有CVD的老年人中抑郁症的患病率高出三倍。这种关联因自评健康状况和功能受限而减弱。此外，这些关联在老年男性中比在老年女性中更为明显。这些发现与先前关于患有CVD的男性心理困扰比女性少的推断不同。此外，研究结果强调了针对CVD相关心理健康的干预和治疗采取针对性别方法的重要性。
