Ganzini L, Smith D M, Fenn D S, Lee M A
Psychiatry Service, Portland VAMC, Oregon 97201, USA.
J Am Geriatr Soc. 1997 Mar;45(3):307-12. doi: 10.1111/j.1532-5415.1997.tb00945.x.
To determine if major depressive disorder influences the survival of older, medically ill veterans.
Thirty month follow-up of an inception cohort.
An academically-affiliated Veterans Affairs Medical Center.
One hundred veterans, half of whom have a depressive disorder, recruited from inpatient medical and surgical units in 1990-1991. At initial evaluation all participants were older than age 65, cognitively intact, and medically but not terminally ill.
Severity of medical illness, functional status, social support and presence of depression were measured at initial evaluation, presence of depression was measured 4 to 6 months after initial evaluation, and survival status was determined at 30 months. Retrospective medical record review was used to determine if patients received depression treatment and to explore whether depressed persons received life-sustaining medical treatment less often than nondepressed persons.
At 30 months, 36 of the 100 subjects had died. Only two factors predicted mortality: severity of medical illness and depression. The survival of subjects who had recovered from depression at 4 to 6 months was intermediate to never depressed and continuously depressed subjects. Somatic treatment of depression did not alter outcome. There was no significant difference between depressed and nondepressed in how often life-sustaining medical treatments were withheld or withdrawn.
Presence of major depression in medically-ill older hospitalized veterans continues to be a risk factor for death 30 months after diagnosis.
确定重度抑郁症是否会影响老年患病退伍军人的生存情况。
对一个起始队列进行30个月的随访。
一家隶属于学术机构的退伍军人事务医疗中心。
1990年至1991年从住院内科和外科病房招募的100名退伍军人，其中一半患有抑郁症。在初次评估时，所有参与者年龄均超过65岁，认知功能正常，患有疾病但并非绝症。
在初次评估时测量疾病严重程度、功能状态、社会支持和是否存在抑郁；在初次评估后4至6个月测量是否存在抑郁；在30个月时确定生存状态。通过回顾医疗记录来确定患者是否接受了抑郁症治疗，并探讨抑郁症患者接受维持生命治疗的频率是否低于非抑郁症患者。
30个月时，100名受试者中有36人死亡。仅有两个因素可预测死亡率：疾病严重程度和抑郁症。在4至6个月时从抑郁症中康复的受试者的生存率介于从未患抑郁症和持续患抑郁症的受试者之间。抑郁症的躯体治疗并未改变结果。在维持生命治疗的 withhold 或 withdraw 频率方面，抑郁症患者和非抑郁症患者之间没有显著差异。
患有严重疾病的老年住院退伍军人中存在重度抑郁症仍然是诊断后30个月死亡的一个风险因素。
