Whooley M A, Browner W S
General Internal Medicine Section, San Francisco Department of Veterans Affairs Medical Center, University of California 94121, USA.
Arch Intern Med. 1998 Oct 26;158(19):2129-35. doi: 10.1001/archinte.158.19.2129.
Major depression is associated with increased mortality, but it is not known whether patients who report depressive symptoms have greater mortality.
We performed a prospective cohort study of 7518 white women 67 years of age or older who were recruited from population-based listings in Baltimore, Md, Minneapolis, Minn, Portland, Ore, and the Monongahela Valley, Pa. Participants completed the Geriatric Depression Scale (short form) and were considered depressed if they reported 6 or more of 15 possible symptoms of depression. Women were followed up for an average of 6 years. If a participant died, we obtained a copy of the official death certificate and hospital records, if available, and used International Classification of Diseases, Ninth Revision, codes to classify death attributable to cardiovascular, cancer, or noncancer, noncardiovascular cause.
Mortality during 7-year follow-up varied from 7% in women with no depressive symptoms to 17% in those with 3 to 5 symptoms to 24% in those with 6 or more symptoms of depression (P<.001). Of 473 women (6.3%) with 6 or more depressive symptoms at baseline, 24% died (111 deaths in 2610 woman-years of follow-up) compared with 11% of women who reported 5 or fewer symptoms of depression (760 deaths in 41 460 woman-years of follow-up) (P<.001). Women with 6 or more depressive symptoms had a 2-fold increased risk of death (age-adjusted hazard ratio [HR], 2.14; 95% confidence interval [CI], 1.75-2.61; P<.001) compared with those who had 5 or fewer depressive symptoms. This association remained strong after adjusting for potential confounding variables, including history of myocardial infarction, stroke, diabetes mellitus, hypertension, chronic obstructive pulmonary disease, smoking, perceived health, and cognitive function (HR, 1.47; 95% CI, 1.14-1.88; P=.003). Depressive symptoms were associated with an increased adjusted risk of death from cardiovascular diseases (HR, 1.8; 95% CI, 1.2-2.5; P= .003), and non-cancer, noncardiovascular diseases (HR, 1.8; 95% CI, 1.2-2.7; P = .01), but were not associated with deaths from cancer (HR, 1.0; 95% CI, 0.6-1.7; P=.93).
Depressive symptoms are a significant risk factor for cardiovascular and noncancer, noncardiovascular mortality but not cancer mortality in older women. Whether depressive symptoms are a marker for, or a cause of, life-threatening conditions remains to be determined.
重度抑郁症与死亡率增加相关，但尚不清楚报告有抑郁症状的患者死亡率是否更高。
我们对7518名67岁及以上的白人女性进行了一项前瞻性队列研究，这些女性是从马里兰州巴尔的摩、明尼苏达州明尼阿波利斯、俄勒冈州波特兰以及宾夕法尼亚州莫农加希拉河谷的人群名单中招募的。参与者完成了老年抑郁量表（简表），如果她们报告了15种可能的抑郁症状中的6种或更多种，则被视为抑郁。对女性进行了平均6年的随访。如果参与者死亡，我们获取了官方死亡证明和医院记录（如有），并使用国际疾病分类第九版编码对归因于心血管疾病、癌症或非癌症、非心血管原因的死亡进行分类。
在7年的随访期间，死亡率从无抑郁症状的女性中的7%到有3至5种症状的女性中的17%，再到有6种或更多抑郁症状的女性中的24%不等（P<0.001）。在基线时有6种或更多抑郁症状的473名女性（6.3%）中，24%死亡（在2610人年的随访中有111例死亡），而报告有5种或更少抑郁症状的女性中有11%死亡（在41460人年的随访中有760例死亡）（P<0.001）。与有5种或更少抑郁症状的女性相比，有6种或更多抑郁症状的女性死亡风险增加了2倍（年龄调整后的风险比[HR]为2.14；95%置信区间[CI]为1.75 - 2.61；P<0.001）。在调整了潜在的混杂变量后，这种关联仍然很强，这些变量包括心肌梗死病史、中风、糖尿病、高血压、慢性阻塞性肺疾病、吸烟、自我感知健康状况和认知功能（HR为1.47；95%CI为1.14 - 1.88；P = 0.003）。抑郁症状与心血管疾病（HR为1.8；95%CI为1.2 - 2.5；P = 0.003）以及非癌症、非心血管疾病（HR为1.8；95%CI为1.2 - 2.7；P = 0.01）的调整后死亡风险增加相关，但与癌症死亡无关（HR为1.0；95%CI为0.6 - 1.7；P = 0.93）。
抑郁症状是老年女性心血管疾病和非癌症、非心血管疾病死亡的重要危险因素，但不是癌症死亡的危险因素。抑郁症状是危及生命状况的标志物还是原因，仍有待确定。
