Callahan C M, Wolinsky F D, Stump T E, Nienaber N A, Hui S L, Tierney W M
Regenstrief Institute for Health Care, Richard L. Roudebush VAMC and the Indiana University School of Medicine, Indianapolis 46202-2859, USA.
J Gen Intern Med. 1998 Nov;13(11):746-52. doi: 10.1046/j.1525-1497.1998.00226.x.
To determine whether depressive symptoms measured at baseline are associated with mortality and to describe the course of depressive symptoms and their relation to physical decline in patients over a 6-year period.
Prospective cohort study conducted from 1990 through 1996.
Urban academic primary care group practice.
A cohort of 3,767 patients aged 60 years and older screened for depressive symptoms during routine office visits using the Centers for Epidemiologic Studies Depression Scale (CES-D) participated in the mortality study. A subsample of 300 patients with CES-D scores 16 or above and a subsample of 100 patients with CES-D scores less than 16 participated in the study of the course of depressive symptoms and physical decline.
Mortality by December 1995 was measured for all screened patients; reinterviewed patients completed the CES-D and the Sickness Impact Profile (SIP). The mean follow-up period was 45 months (+/- SD 12.2 months); 561 (14.9%) of the patients died by December 1995. In proportional hazards models, age, gender, race, history of smoking, serum albumin value, and an ideal body weight in the lowest 10% were significant correlates of time to death, but the baseline CES-D was not. Patients with depressive symptoms had significantly worse physical and psychosocial functioning scores on the SIP than did patients without depressive symptoms. Using the generalized estimating equation method, the strongest predictor of the current CES-D score was the patient's prior CES-D score. However, worsening physical functioning score on the SIP was also independently correlated with worse CES-D scores p < or = .001).
Symptoms of depression were not associated with mortality in this cohort of older adults. However, patients with depressive symptoms reported greater functional impairment than did those without depressive symptoms. Moreover, decline in physical functioning was independently correlated with a concurrent increase in depressive symptoms.
确定基线时测量的抑郁症状是否与死亡率相关，并描述6年间患者抑郁症状的变化过程及其与身体机能衰退的关系。
1990年至1996年进行的前瞻性队列研究。
城市学术性初级保健团体诊所。
一组3767名60岁及以上的患者，在常规门诊就诊时使用流行病学研究中心抑郁量表（CES-D）筛查抑郁症状，参与了死亡率研究。300名CES-D评分16分及以上的患者亚组和100名CES-D评分低于16分的患者亚组参与了抑郁症状变化过程及身体机能衰退的研究。
对所有筛查患者测量至1995年12月的死亡率；再次接受访谈的患者完成了CES-D和疾病影响量表（SIP）。平均随访期为45个月（±标准差12.2个月）；到1995年12月，561名（14.9%）患者死亡。在比例风险模型中，年龄、性别、种族、吸烟史、血清白蛋白值以及体重处于最低10%的理想体重是死亡时间的显著相关因素，但基线CES-D不是。有抑郁症状的患者在SIP上的身体和心理社会功能评分显著低于无抑郁症状的患者。使用广义估计方程法，当前CES-D评分的最强预测因素是患者先前的CES-D评分。然而，SIP上身体功能评分的恶化也与更差的CES-D评分独立相关（p≤0.001）。
在这组老年人中，抑郁症状与死亡率无关。然而，有抑郁症状的患者报告的功能损害比无抑郁症状的患者更大。此外，身体功能的衰退与抑郁症状的同时增加独立相关。
