青少年期抑郁症状加重对青年期健康相关生活质量的影响——一项重复暴露测量的六年队列研究
Effect of elevated depressive symptoms during adolescence on health-related quality of life in young adulthood-a six-year cohort study with repeated exposure measurements.
作者信息
Wiehn Jascha, Kurth Tobias, Ravens-Sieberer Ulrike, Prugger Christof, Piccininni Marco, Reiss Franziska
机构信息
Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
出版信息
Front Pediatr. 2024 Jul 11;12:1252964. doi: 10.3389/fped.2024.1252964. eCollection 2024.
OBJECTIVES
Depression is a major contributor of young people's burden of disease. In this study we aim to estimate the effect of elevated depressive symptoms on physical health-related quality of life.
DESIGN
We used self-reported information from the prospective BELLA cohort study, which included adolescents selected from the general population in Germany. The baseline assessment (2003-2006) and the 1-, 2-, and 6-year follow-up waves provide the data basis.
PARTICIPANTS
The baseline study population consisted of 1,460 adolescents between the ages of 12 and 17 who, according to their caregivers, did not suffer from depression.
VARIABLES
The primary outcome, as measured by the physical component score (PCS) of the SF-36 at a 6-year follow-up (range: 0-100), is physical health-related quality of life. The exposure of interest is depressive symptoms, as measured by the Center for Epidemiological Studies Depression Scale for Children (CES-DC) at baseline, 1-year follow-up and 2-year follow-ups (range: 0-60). We dichotomized the exposure into subthreshold (≤15) and elevated depressive symptoms (>15). For the main analyses we considered a cumulative index for elevated depressive symptoms across the three time points (range: 0-3). Considered confounders are sex, age, socioeconomic status, migrant background, social support, anxiety symptoms, physical activity, chronic diseases, and sleeping problems.
STATISTICAL METHODS
We used multiple imputation to account for missing values. Within each imputed dataset, we applied inverse probability weighting (IPW) to estimate the effect of the cumulative index for elevated depressive symptoms at baseline, 1- and 2-year follow-up on physical health-related quality of life at 6-year follow-up. We derived 95% confidence intervals by bootstrapping.
RESULTS
After adjusting with IPW, the effect of the cumulative index per one unit increase of elevated depressive symptoms on the physical component score was -1.71 (95% CI: -3.51 to -0.04). The adjusted effect estimates of single exposure of elevated depressive symptoms on physical health-related quality of life were -0.83 (95% CI: -3.69 to 1.87) at baseline, -2.96 (95% CI: -4.94 to -0.52) at 1-year follow-up and -1.32 (95% CI: -3.85 to 1.15) at 2-year follow-up.
CONCLUSION
Findings suggest that elevated depressive symptoms during adolescence decrease physical health-related quality of life in young adulthood.
目的
抑郁症是年轻人疾病负担的主要促成因素。在本研究中，我们旨在评估抑郁症状加重对与身体健康相关的生活质量的影响。
设计
我们使用了前瞻性BELLA队列研究中的自我报告信息，该研究纳入了从德国普通人群中选取的青少年。基线评估（2003 - 2006年）以及1年、2年和6年的随访提供了数据基础。
参与者
基线研究人群包括1460名年龄在12至17岁之间的青少年，据其照顾者称，他们没有患抑郁症。
变量
主要结局是在6年随访时通过SF - 36的身体成分评分（PCS）衡量的与身体健康相关的生活质量（范围：0 - 100）。感兴趣的暴露因素是抑郁症状，通过儿童流行病学研究中心抑郁量表（CES - DC）在基线、1年随访和2年随访时进行测量（范围：0 - 60）。我们将暴露因素分为亚阈值（≤15）和抑郁症状加重（>15）。对于主要分析，我们考虑了三个时间点上抑郁症状加重的累积指数（范围：0 - 3）。考虑的混杂因素包括性别、年龄、社会经济地位、移民背景、社会支持、焦虑症状、身体活动、慢性病和睡眠问题。
统计方法
我们使用多重填补法处理缺失值。在每个填补数据集中，我们应用逆概率加权（IPW）来估计基线、1年和2年随访时抑郁症状加重的累积指数对6年随访时与身体健康相关的生活质量的影响。我们通过自抽样得出95%置信区间。
结果
经IPW调整后，抑郁症状加重的累积指数每增加一个单位对身体成分评分的影响为 - 1.71（95%置信区间： - 3.51至 - 0.04）。抑郁症状加重的单次暴露对与身体健康相关的生活质量的调整效应估计值在基线时为 - 0.83（95%置信区间： - 3.69至1.87），在1年随访时为 - 2.96（95%置信区间： - 4.94至 - 0.52），在2年随访时为 - 1.32（95%置信区间： - 3.85至1.15）。
结论
研究结果表明，青少年时期抑郁症状加重会降低青年期与身体健康相关的生活质量。
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