Anda R, Williamson D, Jones D, Macera C, Eaker E, Glassman A, Marks J
National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
Epidemiology. 1993 Jul;4(4):285-94. doi: 10.1097/00001648-199307000-00003.
Major depression has been associated with mortality from ischemic heart disease (IHD). In addition, a symptom of depression--hopelessness--has been suggested as a determinant of health status. We studied the relation of both depressed affect and hopelessness to IHD incidence using data from a cohort of 2,832 U.S. adults age 45-77 years who participated in the National Health Examination Follow-up Study (mean follow-up = 12.4 years) and had no history of IHD or serious illness at baseline. We used the depression subscale of the General Well-Being Schedule to define depressed affect and a single item from the scale to define hopelessness. At baseline, 11.1% of the cohort had depressed affect; 10.8% reported moderate hopelessness, and 2.9% reported severe hopelessness. Depressed affect and hopelessness were more common among women, blacks, and persons who were less educated, unmarried, smokers, or physically inactive. There were 189 cases of fatal IHD during the follow-up period. After we adjusted for demographic and risk factors, depressed affect was related to fatal IHD [relative risk = 1.5; 95% confidence interval (CI) = 1.0-2.3]; the relative risks of fatal IHD for moderate and severe levels of hopelessness were 1.6 (95% CI = 1.0-2.5) and 2.1 (95% CI = 1.1-3.9), respectively. Depressed affect and hopelessness were also associated with an increased risk of nonfatal IHD. These data indicate that depressed affect and hopelessness may play a causal role in the occurrence of both fatal and nonfatal IHD.
重度抑郁症与缺血性心脏病（IHD）导致的死亡率相关。此外，抑郁的一种症状——绝望感——被认为是健康状况的一个决定因素。我们利用来自2832名年龄在45 - 77岁的美国成年人队列的数据，研究了抑郁情绪和绝望感与IHD发病率之间的关系。这些成年人参与了国家健康检查后续研究（平均随访时间 = 12.4年），且在基线时无IHD或严重疾病史。我们使用总体幸福感量表的抑郁分量表来定义抑郁情绪，并使用该量表中的一个单项来定义绝望感。在基线时，该队列中11.1%的人有抑郁情绪；10.8%的人报告有中度绝望感，2.9%的人报告有重度绝望感。抑郁情绪和绝望感在女性、黑人以及受教育程度较低、未婚、吸烟或缺乏身体活动的人群中更为常见。随访期间有189例致命性IHD病例。在我们对人口统计学和风险因素进行调整后，抑郁情绪与致命性IHD相关[相对风险 = 1.5；95%置信区间（CI）= 1.0 - 2.3]；中度和重度绝望感导致致命性IHD的相对风险分别为1.6（95% CI = 1.0 - 2.5）和2.1（95% CI = 1.1 - 3.9）。抑郁情绪和绝望感还与非致命性IHD风险增加相关。这些数据表明，抑郁情绪和绝望感可能在致命性和非致命性IHD的发生中起因果作用。
