慢性疾病状况与中老年人群抑郁症状转变的关联：基于马尔可夫模型队列研究的启示。
Association between chronic disease status and transitions in depressive symptoms among middle-aged and older Chinese population: Insights from a Markov model-based cohort study.
机构信息
Department of Population Health and Aging Science, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences/Peking Union Medical College, No. 31, Road 3rd, Bei-Ji-Ge, Dongcheng District, Beijing 100730, China.
Department of Population Health and Aging Science, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences/Peking Union Medical College, No. 31, Road 3rd, Bei-Ji-Ge, Dongcheng District, Beijing 100730, China; APEC Health Science Academy, Peking University, Beijing, China.
出版信息
J Affect Disord. 2024 Oct 15;363:445-455. doi: 10.1016/j.jad.2024.07.116. Epub 2024 Jul 18.
BACKGROUND
The relationship between chronic disease status (CDS) and transitions in depressive symptoms (DS) remains unclear. This study explores the association between CDS and DS transitions.
METHODS
This cohort study analyzed data from 8175 participants aged 45+, sourced from China Family Panel Studies (2016, 2018, 2020). DS were assessed using a brief version of Center for Epidemiologic Studies Depression Scale (CES-D). CDS was categorized into healthy, single disease, and multimorbidity. Markov models were used to estimate state transition intensities, mean sojourn times and hazard ratios (HRs).
RESULTS
DS transitions occurred between adjacent and non-adjacent states, but transition intensity between adjacent states was higher than among non-adjacent states. Self-transition intensities of severe-DS, mild-DS, and non-DS progressively increased, with average durations of 1.365, 1.482, and 7.854 years, respectively. Both single disease and multimorbidity were significantly associated with an increased risk of transitioning from non-DS to mild-DS, with multimorbidity showing a stronger association. In contrast, HRs for single diseases transitioning from mild-DS to severe-DS were significantly lower than 1. Furthermore, their HRs were almost <1 in recovery transitions but not statistically significant.
LIMITATIONS
Specific chronic diseases and their combinations were not analyzed.
CONCLUSIONS
The progression of DS exhibits various pathways. CDS is associated with DS transitions, but the roles of single disease and multimorbidity may differ across different DS progression stages. Both conditions were significantly linked to the risk of new-onset DS, with multimorbidity posing a greater association. However, this relationship is not observed in other progression stages. These findings could provide insights for early prevention and intervention for DS.
背景
慢性病状况（CDS）与抑郁症状（DS）的转变之间的关系尚不清楚。本研究探讨了 CDS 与 DS 转变之间的关联。
方法
本队列研究分析了来自中国家庭追踪调查（2016、2018、2020 年）的 8175 名 45 岁及以上参与者的数据。使用中心流行病学研究抑郁量表（CES-D）的简短版本评估 DS。将 CDS 分为健康、单疾病和多种疾病。使用马尔可夫模型估计状态转移强度、平均停留时间和风险比（HR）。
结果
DS 发生在相邻和非相邻状态之间的转移，但相邻状态之间的转移强度高于非相邻状态。严重 DS、轻度 DS 和非 DS 的自我转移强度逐渐增加，平均持续时间分别为 1.365、1.482 和 7.854 年。单疾病和多种疾病均与从非 DS 向轻度 DS 转变的风险增加显著相关，且多种疾病的关联更强。相比之下，从轻度 DS 向严重 DS 转变的单疾病的 HR 显著低于 1。此外，它们在恢复性转变中的 HR 几乎<1，但无统计学意义。
局限性
未分析特定的慢性疾病及其组合。
结论
DS 的进展表现出不同的途径。CDS 与 DS 转变相关，但单疾病和多种疾病的作用在不同的 DS 进展阶段可能不同。两种情况均与新发 DS 的风险显著相关，且多种疾病的关联更强。然而，这种关系在其他进展阶段并不明显。这些发现为 DS 的早期预防和干预提供了依据。
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