Everson S A, Roberts R E, Goldberg D E, Kaplan G A
Human Population Laboratory, Public Health Institute, Berkeley, Calif, USA.
Arch Intern Med. 1998 May 25;158(10):1133-8. doi: 10.1001/archinte.158.10.1133.
Several lines of evidence indicate that depression is importantly associated with cardiovascular disease end points. However, little is known about the role of depression in stroke mortality.
This study examined the association between depressive symptoms and stroke mortality in a prospective study of behavioral, social, and psychological factors related to health and mortality in a community sample of 6676 initially stroke-free adults (45.8% male; 79.1% white; mean age at baseline, 43.4 years) from Alameda County, California. Depressive symptoms were assessed by the 18-item Human Population Laboratory Depression Scale. Cox proportional hazards regression models were used to evaluate the impact of depressive symptoms after controlling for age, sex, race, and other confounders.
A total of 169 stroke deaths occurred during 29 years of follow-up. Reporting 5 or more depressive symptoms at baseline was associated with increased risk of stroke mortality, after adjusting for age, sex, and race (hazard ratio, 1.66; 95% confidence interval, 1.16-2.39; P<.006). This association remained significant after additional adjustments for education, alcohol consumption, smoking, body mass index, hypertension, and diabetes (hazard ratio, 1.54; 95% confidence interval, 1.06-2.22; P<.02). Time-dependent covariate models, which allowed changes in reported depressive symptoms and risk factor levels during follow-up, revealed the same pattern of associations.
This population-based study provides the strongest epidemiological evidence to date for a significant relationship between depressive symptoms and stroke mortality. These results contribute to the growing literature on the adverse health effects of depression.
多项证据表明，抑郁症与心血管疾病终点密切相关。然而，抑郁症在中风死亡率中的作用却鲜为人知。
本研究在一项针对加利福尼亚州阿拉米达县6676名最初无中风的成年人（男性占45.8%；白人占79.1%；基线平均年龄43.4岁）的健康与死亡率相关行为、社会和心理因素的前瞻性研究中，考察了抑郁症状与中风死亡率之间的关联。抑郁症状通过18项人类人口实验室抑郁量表进行评估。采用Cox比例风险回归模型，在控制年龄、性别、种族和其他混杂因素后，评估抑郁症状的影响。
在29年的随访期间，共发生了169例中风死亡。在调整年龄、性别和种族后，基线时报告有5种或更多抑郁症状与中风死亡率增加相关（风险比为1.66；95%置信区间为1.16 - 2.39；P <.006）。在进一步调整教育程度、饮酒、吸烟、体重指数、高血压和糖尿病后，这种关联仍然显著（风险比为1.54；95%置信区间为1.06 - 2.22；P <.02）。时间依存协变量模型允许随访期间报告的抑郁症状和危险因素水平发生变化，揭示了相同的关联模式。
这项基于人群的研究提供了迄今为止关于抑郁症状与中风死亡率之间显著关系的最有力的流行病学证据。这些结果为关于抑郁症对健康产生不良影响的文献增添了内容。
