Association between depression and mortality in older adults - The Cardiovascular Health Study
Association between depression and mortality in older adults - The Cardiovascular Health Study
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DOI：
10.1001/archinte.160.12.1761
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发表时间：
2000-06-26
影响因子：
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通讯作者：
Kop, WJ
中科院分区：
文献类型：
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作者：
Schulz, R;Beach, SR;Kop, WJ
背景：关于老年人抑郁症状与死亡率之间关系的研究得出了相互矛盾的结果。为了解决这些差异，我们使用迄今为止研究过的最广泛的一系列社会人口统计学和身体健康控制变量来测试这种关联，据我们所知，在一个基于人口的大型老年人样本中。目的：研究老年人基线抑郁症状与6年全因死亡率之间的关系，系统控制社会人口学因素、临床疾病、亚临床疾病、方法：来自美国4个社区的5201名65岁及以上的男性和女性参与了这项研究。在基线时评估抑郁症状和4类协变量。主要的结局指标是B年死亡率。结果：在5201名参与者中，984人（18.9%）在6年内死亡。高基线抑郁症状的死亡率（23.9%）高于低基线抑郁评分的死亡率（17.7%）（未校正的相对风险[RR]，1.41; 95%置信区间[CI]，1.22-1.63）。在控制了社会人口统计学因素后，抑郁症也是死亡率的独立预测因子（RR，1.43; 95% CI，1.23-1.66），流行临床疾病（RR，1.25; 95% CI，1.07-1.45），亚临床疾病指标（RR，1.35; 95% CI，1.15-1.58），或生物或行为危险因素（RR，1.42; 95% CI，1.22-1.65）。当所有4类变量中的最佳预测因子作为协变量时，高抑郁症状仍然是死亡率的独立预测因子（RR，1.24; 95%CI，1.06-1.46）。结论：高水平的抑郁症状是社区老年人死亡率的独立危险因素。动机耗竭可能是抑郁-死亡效应的一个关键潜在机制。
Background: Studies of the association between depressive symptoms and mortality in elderly populations have yielded contradictory findings. To address these discrepancies, we test this association using the most extensive array of sociodemographic and physical health control variables ever studied, to our knowledge, in a large population-based sample of elderly individuals.Objective: To examine the relation between baseline depressive symptoms and 6-year all-cause mortality in older persons, systematically controlling for sociodemographic factors, clinical disease, subclinical disease, and health risk factors.Methods: A total of 5201 men and women aged 65 years and older from 4 US communities participated in the study. Depressive symptoms and 4 categories of covariates were assessed at baseline. The primary outcome measure was B-year mortality.Results: Of the 5201 participants, 984 (18.9%) died within 6 years. High baseline depressive symptoms were associated with a higher mortality rate (23.9%) than low baseline depression scores (17.7%) (unadjusted relative risk [RR], 1.41; 95% confidence interval [CI], 1.22-1.63). Depression was also an independent predictor of mortality when controlling for sociodemographic factors (RR, 1.43; 95% CI, 1.23-1.66), prevalent clinical disease (RR, 1.25; 95% CI, 1.07-1.45), subclinical disease indicators (RR, 1.35; 95% CI, 1.15-1.58), or biological or behavioral risk factors (RR, 1.42; 95% CI, 1.22-1.65). When the best predictors from all 4 classes of variables were included as covariates, high depressive symptoms remained an independent predictor of mortality (RR, 1.24; 95% CI, 1.06-1.46).Conclusions: High levels of depressive symptoms are an independent risk factor for mortality in community-residing older adults. Motivational depletion may be a key underlying mechanism for the depression-mortality effect.