Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts.
Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California.
JAMA Netw Open. 2024 Apr 1;7(4):e244602. doi: 10.1001/jamanetworkopen.2024.4602.
Although cardiovascular disease (CVD) is a known risk factor for depression, evidence is lacking regarding whether and to what extent a spouse's CVD is associated with the subsequent mental health of individuals.
To examine the association between CVD onset in spouses and subsequent depression.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study examined 277 142 matched married couples enrolled in the Japan Health Insurance Association health insurance program between April 2015 and March 2022, covering approximately 40% of the working-age population in Japan. Index individuals (primary insured) whose spouses (dependent) experienced incident CVD between April 2016 and March 2022 were 1:1 matched to controls whose spouses did not experience CVD. Matching was based on age, sex, income, or the onset date of the spouses' CVD. Data analysis was conducted from April 2016 to March 2022.
Spousal onset of CVD between fiscal years 2016 and 2021. The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes were used to identify the composite CVD outcomes (stroke, heart failure, and myocardial infarction).
Multivariate Cox proportional hazards models were used to investigate the association between spouses' new-onset CVD and individuals' depression, adjusting for sociodemographic characteristics and comorbidities of index individuals (diabetes, hypertension, and CVD) and spouses (diabetes, hypertension, and depression). Subgroup analyses were conducted according to sex, age, income levels, and history of CVD.
Among 277 142 matched pairs of married couples, 263 610 (95.1%) had a male index individual; the mean (SD) age of index individuals was 58.2 (10.2) years. A new onset of depression was observed in 4876 individuals (1.8%). In multivariable Cox models, there was an association between the spouse's CVD and the individuals' depression (hazard ratio, 1.13 [95% CI, 1.07-1.20]). The subgroup analysis found no evidence of heterogeneity in sex, age, income level, or CVD history. The results were consistent when additionally adjusted for health behaviors (smoking, alcohol consumption, physical activity, and use of antihypertensive drugs) and objectively measured physical health conditions (body mass index, blood pressure, cholesterol levels, glucose levels, and estimated glomerular filtration rate) (hazard ratio, 1.16 [95% CI, 1.06-1.28]).
In this nationwide cohort study of matched couples, a spouse's onset of CVD was associated with an increased risk of an individual's depression. These findings highlight the importance of preventive care for mental health disorders in individuals whose spouses experience incident CVD.
虽然心血管疾病（CVD）是抑郁症的已知危险因素，但关于配偶的 CVD 是否以及在何种程度上与个体随后的心理健康有关，证据仍然缺乏。
研究配偶 CVD 发病与随后抑郁之间的关系。
设计、地点和参与者：这项队列研究纳入了 2015 年 4 月至 2022 年 3 月期间参加日本健康保险协会健康保险计划的 277142 对已婚夫妇，该计划覆盖了日本大约 40%的劳动年龄人口。2016 年 4 月至 2022 年 3 月期间，配偶（受抚养人）发生 CVD 事件的索引个体（主要参保人）与配偶未发生 CVD 的对照个体（对照）以 1:1 比例匹配。匹配基于年龄、性别、收入或配偶 CVD 的发病日期。数据分析于 2016 年 4 月至 2022 年 3 月进行。
配偶在 2016 年至 2021 年期间新发生的 CVD。使用国际疾病分类第十版对复合 CVD 结局（中风、心力衰竭和心肌梗死）进行编码。
使用多变量 Cox 比例风险模型，在调整了索引个体（糖尿病、高血压和 CVD）和配偶（糖尿病、高血压和抑郁）的社会人口统计学特征和合并症后，研究了配偶新发 CVD 与个体抑郁之间的关系。根据性别、年龄、收入水平和 CVD 病史进行了亚组分析。
在 277142 对已婚夫妇中，有 263610 对（95.1%）的索引个体为男性；索引个体的平均（SD）年龄为 58.2（10.2）岁。有 4876 人（1.8%）出现新的抑郁发作。在多变量 Cox 模型中，配偶的 CVD 与个体的抑郁有关（风险比，1.13[95%CI，1.07-1.20]）。亚组分析未发现性别、年龄、收入水平或 CVD 病史方面存在异质性。当进一步调整健康行为（吸烟、饮酒、体力活动和使用抗高血压药物）和客观测量的身体健康状况（体重指数、血压、胆固醇水平、血糖水平和估计肾小球滤过率）时，结果一致（风险比，1.16[95%CI，1.06-1.28]）。
在这项针对已婚夫妇的全国性队列研究中，配偶 CVD 的发病与个体患抑郁症的风险增加有关。这些发现强调了在配偶发生 CVD 事件的个体中，进行心理健康障碍预防护理的重要性。
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