Ballin Marcel, Ekblom Örjan, Nordström Anna, Ahlqvist Viktor H, Nordström Peter
Department of Public Health and Caring Sciences, Clinical Geriatrics, Uppsala University, Uppsala, Sweden.
Department of Physical Activity and Health, The Swedish School of Sport and Health Sciences, Stockholm, Sweden.
J Intern Med. 2025 Sep;298(3):200-213. doi: 10.1111/joim.20109. Epub 2025 Jul 9.
Examine the association between adolescent cardiorespiratory fitness and future risk of depression and dispensation of antidepressants, including the role of familial confounding.
A cohort study with sibling-comparisons based on Swedish men who participated in mandatory military conscription examinations from 1972 to 1995. The exposure was cardiorespiratory fitness estimated using a maximal ergometer bicycle test. The outcomes were depression diagnosis in specialized outpatient or inpatient care and dispensation of antidepressants until 31 December 2023.
A total of 1,013,885 men (mean age 18.3 years), of which 410,198 were full siblings, were followed until a median age of 56.8 years, during which 47,283 were diagnosed with depression and 237,409 were dispensed antidepressants. In cohort analysis, the highest decile of fitness had lower risks of depression (adjusted hazard ratio [HR] 0.54, [95% confidence interval, 0.52, 0.57]) and antidepressants (HR 0.63; 0.62, 0.65) compared to the lowest decile, with differences in the standardized cumulative incidence by age 65 of -3.9% and -12.3%, respectively. In sibling-comparison analyses accounting for unobserved familial confounders, the associations attenuated for both depression (HR 0.67, 0.59-0.75; incidence difference -2.4%) and antidepressants (HR 0.76, 0.72-0.80; incidence difference -7.2%). Hypothetically shifting everyone to the highest decile of fitness was associated with a preventable fraction of 29.1% for depression and 17.8% for antidepressants in cohort analysis, which attenuated to 17.6% and 10.4% in sibling-comparisons.
High levels of adolescent cardiorespiratory fitness are associated with lower risks of future depression and antidepressants, but the associations might be overstated due to familial confounding.
研究青少年心肺适能与未来患抑郁症风险及抗抑郁药使用之间的关联，包括家族混杂因素的作用。
一项队列研究，对1972年至1995年参加瑞典义务兵役检查的男性进行同胞比较。暴露因素是通过最大运动强度自行车测试估计的心肺适能。结局指标是在专科门诊或住院治疗中被诊断为抑郁症以及截至2023年12月31日使用抗抑郁药的情况。
共随访了1,013,885名男性（平均年龄18.3岁），其中410,198名是全同胞，随访至年龄中位数为56.8岁，在此期间，47,283人被诊断为抑郁症，237,409人使用了抗抑郁药。在队列分析中，与体能最低的十分位数相比，体能最高的十分位数患抑郁症（调整后风险比[HR]0.54，[95%置信区间，0.52, 0.57]）和使用抗抑郁药（HR 0.63；0.62, 0.65）的风险较低，到65岁时标准化累积发病率差异分别为-3.9%和-12.3%。在考虑未观察到的家族混杂因素的同胞比较分析中，抑郁症（HR 0.67，0.59 - 0.75；发病率差异-2.4%）和抗抑郁药（HR 0.76，0.72 - 0.80；发病率差异-7.2%）的关联均减弱。在队列分析中，假设将每个人的体能提升到最高十分位数，抑郁症的可预防比例为29.1%，抗抑郁药的可预防比例为17.8%，在同胞比较中分别降至17.6%和10.4%。
青少年高水平的心肺适能与未来患抑郁症和使用抗抑郁药的较低风险相关，但由于家族混杂因素，这种关联可能被高估。
