Parmelee P A, Lawton M P, Katz I R
Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, USA.
J Gerontol A Biol Sci Med Sci. 1998 Mar;53(2):M155-62. doi: 10.1093/gerona/53a.2.m155.
Confounding of depression with somatic illness and anxiety, a problem in any age group, may be especially troublesome in frail older persons. This paper examined this problem in a factor analytic study of the structure of depressive symptomatology, identifying affective and somatic symptom clusters and relating those clusters to health and functional variables cross-sectionally and prospectively over a 1-year interval.
The factor structure of a DSM-IV symptom checklist was examined among 1,245 elderly long-term care residents. Regression analyses examined the association of resulting factors with cognition, functional disability, self- and physician-rated health, and pain at baseline and a year later. One-year mortality was also examined.
Factor analysis revealed three unique symptom clusters: depressed mood, somatic symptoms, and psychic anxiety. Depressed mood and somatic symptoms were associated cross-sectionally with all functional health variables, but psychic anxiety was associated only with pain. Longitudinally, depressed mood was the only independent predictor of decline in cognition, functional ability, physician-rated health, and mortality; the last effect, however, did not withstand control for baseline health and functioning. Somatic symptoms at baseline predicted decrement in self-rated health a year later. Effects varied as a function of cognitive status.
These data suggest that concerns about the confounding role of somatic symptoms in the association of depression with physical health are unfounded. Although somatic symptoms of depression and anxiety were associated with health and functional status cross-sectionally, depressed mood was by far the stronger predictor of health declines over time.
抑郁症与躯体疾病及焦虑症的混淆在任何年龄组都是个问题，在体弱的老年人中可能尤其棘手。本文在一项关于抑郁症状结构的因素分析研究中探讨了这个问题，识别出情感和躯体症状群，并在一年的时间间隔内，对这些症状群与健康及功能变量进行横断面和前瞻性关联分析。
对1245名老年长期护理居民进行了《精神疾病诊断与统计手册》第四版症状清单的因素结构研究。回归分析检验了所得因素与认知、功能残疾、自我及医生评定的健康状况以及基线和一年后的疼痛之间的关联。还对一年死亡率进行了检验。
因素分析揭示了三个独特的症状群：情绪低落、躯体症状和精神焦虑。情绪低落和躯体症状在横断面上与所有功能健康变量相关，但精神焦虑仅与疼痛相关。纵向来看，情绪低落是认知、功能能力、医生评定的健康状况和死亡率下降的唯一独立预测因素；然而，最后的这个效应在控制了基线健康和功能状况后并不成立。基线时的躯体症状可预测一年后自我评定健康状况的下降。效应因认知状态而异。
这些数据表明，对躯体症状在抑郁症与身体健康关联中所起的混淆作用的担忧是没有根据的。虽然抑郁和焦虑的躯体症状在横断面上与健康和功能状态相关，但情绪低落是随时间推移健康状况下降的更强有力的预测因素。
