Komura Toshiaki, Tsugawa Yusuke, Yabe Daisuke, Kondo Naoki, Inoue Kosuke
Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, United States.
Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States.
Am J Epidemiol. 2025 Sep 3;194(9):2715-2723. doi: 10.1093/aje/kwaf075.
Little is known about whether spouse's diabetes is associated with subsequent depression of individuals. Moreover, evidence is lacking regarding whether a spouse's subsequent cardiovascular disease (CVD) mediates its association. We examined 521 010 married couples enrolled in the Japan Health Insurance Association Health Insurance Program between 2015 and 2021. The index individuals (primary insured) were depression-free when their spouse (dependent) experienced the first diabetes diagnosis between 2016 and 2021. Each index individual was matched in a 1:1 ratio. Cox proportional hazard models were used to estimate the association between spouses' diabetes and individuals' new-onset depression. Mediation analysis was used to quantify the mediating role of CVD on this association. Among matched index individuals (mean age, 54.1), spouse's CVD occurred in 38 281 cases (7.3%) over a median follow-up of 34 months. The spouse's diabetes was associated with an individual's depression (HR, 1.08 [95% CI, 1.04-1.12]), and the estimated pure indirect effect was 1.02 (95% CI, 1.00-1.03). When using dependents as index individuals, we found a similar magnitude of total effect while the indirect effect was null. These findings highlight the importance of household-level mental health support for patients with diabetes following its diagnosis, as well as preventing CVD in the patients themselves.
关于配偶患糖尿病是否与个体随后出现的抑郁症有关，目前所知甚少。此外，关于配偶随后患心血管疾病（CVD）是否介导了这种关联，也缺乏相关证据。我们研究了2015年至2021年期间参加日本健康保险协会健康保险计划的521010对已婚夫妇。当他们的配偶（受抚养人）在2016年至2021年期间首次被诊断出患有糖尿病时，索引个体（主要参保人）没有抑郁症。每个索引个体按1:1的比例进行匹配。使用Cox比例风险模型来估计配偶患糖尿病与个体新发抑郁症之间的关联。中介分析用于量化CVD在这种关联中的中介作用。在匹配的索引个体（平均年龄54.1岁）中，在34个月的中位随访期内，配偶患CVD的有38281例（7.3%）。配偶患糖尿病与个体患抑郁症有关（HR，1.08 [95%CI，1.04 - 1.12]），估计的纯间接效应为1.02（95%CI，1.00 - 1.03）。当将受抚养人作为索引个体时，我们发现总效应的大小相似，而间接效应为零。这些发现凸显了在糖尿病患者确诊后提供家庭层面心理健康支持的重要性，以及预防患者自身患CVD的重要性。
