Gallo J J, Rabins P V, Lyketsos C G, Tien A Y, Anthony J C
Department of Mental Hygiene, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
J Am Geriatr Soc. 1997 May;45(5):570-8. doi: 10.1111/j.1532-5415.1997.tb03089.x.
We hypothesized that depressive symptoms not meeting full standard criteria for Major Depression would be associated with significant functional impairment among older adults over the course of a 13-year follow-up interval. Specifically, we developed criteria for a form of depression whose core symptoms did not include sadness or dysphoria.
Population-based 13-year follow-up survey.
Community-dwelling adults living in East Baltimore in 1981.
Subjects were the 1612 participants of the Baltimore sample of the Epidemiologic Catchment Area Program aged 50 years and older at the initial interview in 1981.
The subjects were sorted into four categories based on their responses at baseline: (1) persons meeting standard criteria for Major Depression; (2) persons meeting alternative criteria for depression with dysphoria or (3) without dysphoria; and (4) a comparison category of persons not meeting any criteria for depression ("noncases"). The mortality and functional status of each group were compared after a 13-year follow-up interval.
Compared with non-cases, participants aged 50 years and older who reported depressive symptoms but who denied sadness or dysphoria (nondysphoric depression) were at increased risk for death (relative risk (RR) = 1.70; 95% confidence interval (CI) (1.09, 2.67)), impairment in activities of daily living (RR = 3.76; 95% CI (1.73, 8.14)), impairment in instrumental activities of daily living (RR = 5.07; 95% CI (2.24, 11.44)), psychologic distress (RR = 3.68; 95% CI (1.47, 9.21)), and cognitive impairment (RR = 3.00; 95% CI (1.31, 6.89)) after a 13-year follow-up interval. The findings were not wholly explained by potentially influential baseline characteristics such as age, education, selected comorbid medical conditions, and functional status.
Among adults aged 50 years and older, nondysphoric depression may be as important as Major Depression in relation to the development of functional disability and other long-term outcomes.
我们假设，不符合重度抑郁症完整标准的抑郁症状，在13年的随访期间，会与老年人的显著功能障碍相关。具体而言，我们制定了一种抑郁症的标准，其核心症状不包括悲伤或烦躁不安。
基于人群的13年随访调查。
1981年居住在东巴尔的摩的社区居民。
研究对象为1981年首次访谈时年龄在50岁及以上的流行病学集水区项目巴尔的摩样本中的1612名参与者。
根据受试者在基线时的回答将其分为四类：（1）符合重度抑郁症标准的人；（2）符合伴有烦躁不安或（3）不伴有烦躁不安的抑郁症替代标准的人；以及（4）不符合任何抑郁症标准的对照人群（“非病例”）。在13年的随访期后，比较了每组的死亡率和功能状态。
与非病例相比，报告有抑郁症状但否认悲伤或烦躁不安（无烦躁不安的抑郁症）的50岁及以上参与者，在13年的随访期后，死亡风险增加（相对风险（RR）=1.70；95%置信区间（CI）（1.09，2.67）），日常生活活动受损（RR = 3.76；95%CI（1.73，8.14）），工具性日常生活活动受损（RR = 5.07；95%CI（2.24，11.44）），心理困扰（RR = 3.68；95%CI（1.47，9.21）），以及认知障碍（RR = 3.00；95%CI（1.31，6.89））。这些发现并不能完全由年龄、教育程度、选定的合并症和功能状态等潜在影响基线特征来解释。
在50岁及以上的成年人中，无烦躁不安的抑郁症在功能残疾和其他长期后果的发展方面可能与重度抑郁症同样重要。
