Ormel J, Kempen G I, Deeg D J, Brilman E I, van Sonderen E, Relyveld J
Department of Social Psychiatry, University of Groningen, The Netherlands.
J Am Geriatr Soc. 1998 Jan;46(1):39-48. doi: 10.1111/j.1532-5415.1998.tb01011.x.
To expand the landmark Medical Outcomes Study (MOS) and World Health Organization (WHO) findings on the unique association of symptoms of depression with multiple domains of functioning, health perception, and well-being in consulting populations to the late middle-aged and older community-dwelling population and to contrast this unique association to that of specific chronic medical conditions and sensory and cognitive impairment (collectively denoted as medical conditions (MCs)).
Population-based, cross-sectional health survey.
A total of 5279 noninstitutionalized late middle-aged and older persons living independently or in residential homes for older people housing in the northern part of The Netherlands.
Behavioral: physical functioning, (Independent) Activities of Daily Living ((1)ADL), and role functioning. Subjective: health perception, life satisfaction and well-being. Mixed: discretionary activities and activity level. Two aspects of the association were examined: the unique risk (adjusted difference in mean outcome between those with the condition and those without, expressed in SD units) and the unique contribution (adjusted proportion of variance in outcome accounted for by the condition). The latter takes the prevalence of the condition into account.
Among both individuals with MCs and those without, persons with symptoms of depression did worse on all outcomes than those without. Depressive symptoms were more consequential for subjective and mixed outcomes compared with behavioral outcomes. For all outcomes, none of the unique contributions of MCs exceeded that of depressive symptoms, whereas the unique contribution of depressive symptoms typically outranked those of the MCs. For behavioral outcomes, the unique risks associated with neurological conditions, persistent back problem, arthritis, and stroke exceeded that of depressive symptoms, but risk associated with depressive symptoms exceeded that of nine of 18 MCs, on average. For the mixed and subjective outcomes, none of the unique risks associated with MCs exceeded that of depressive symptoms, but risks of depressive symptoms exceeded those of 16 of the 18 MCs, on average. The effects of depressive symptoms and medical conditions were largely additive although depressive symptoms amplified the effect of some medical conditions on (I)ADL. The pattern of unique risks and contributions was similar across all ages (57-64, 65-74, 75+).
The unique contribution of depressive symptoms in dysfunction, poor health perception, and well-being typically exceeds that of medical conditions because depressive symptoms combine a moderately large unique risk with a rather high prevalence. Results expand the MOS and WHO findings to the community-dwelling late middle-aged and older population and to additional outcomes as well. Results underscore the importance of detection and management of (comorbid) symptoms of depression in older people.
将具有里程碑意义的医学结果研究（MOS）和世界卫生组织（WHO）关于咨询人群中抑郁症状与多个功能领域、健康认知及幸福感之间独特关联的研究结果扩展至中老年社区居住人群，并将这种独特关联与特定慢性疾病、感官和认知障碍（统称为医疗状况（MCs））的关联进行对比。
基于人群的横断面健康调查。
荷兰北部总共5279名未入住机构的中老年独立生活者或居住在养老院的老年人。
行为方面：身体功能、（独立）日常生活活动能力（(1)ADL）及角色功能。主观方面：健康认知、生活满意度及幸福感。综合方面：自主活动及活动水平。研究了关联的两个方面：独特风险（患病者与未患病者平均结果的调整差异，以标准差单位表示）和独特贡献（该状况在结果中所占的调整方差比例）。后者考虑了该状况的患病率。
在患有MCs和未患有MCs的个体中，有抑郁症状的人在所有结果方面均比无抑郁症状的人表现更差。与行为结果相比，抑郁症状对主观和综合结果的影响更大。对于所有结果，MCs的独特贡献均未超过抑郁症状的独特贡献，而抑郁症状的独特贡献通常高于MCs。对于行为结果，与神经系统疾病、持续性背部问题、关节炎和中风相关的独特风险超过了抑郁症状的风险，但抑郁症状的风险平均超过了18种MCs中的9种。对于综合和主观结果，与MCs相关的独特风险均未超过抑郁症状的风险，但抑郁症状的风险平均超过了18种MCs中的16种。抑郁症状和医疗状况的影响在很大程度上是相加的，尽管抑郁症状会放大某些医疗状况对(1)ADL的影响。在所有年龄段（57 - 64岁、65 - 74岁、75岁及以上），独特风险和贡献的模式相似。
抑郁症状在功能障碍、健康认知不良和幸福感方面的独特贡献通常超过医疗状况，因为抑郁症状兼具中等程度的较大独特风险和相当高的患病率。研究结果将MOS和WHO的研究结果扩展至社区居住的中老年人群以及更多结果。结果强调了在老年人中检测和管理（共病）抑郁症状的重要性。
