Depressive symptoms and survival of patients with coronary artery disease
Depressive symptoms and survival of patients with coronary artery disease
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DOI：
10.1097/00006842-200011000-00008
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发表时间：
2000-11-01
影响因子：
3.3
通讯作者：
Williams, RB
中科院分区：
文献类型：
--
作者：
Barefoot, JC;Brummett, BH;Williams, RB
目的：多项研究表明，高水平的抑郁症状会增加既往冠心病患者的死亡风险。本研究将抑郁症状分组，以评估抑郁症状在预测生存方面的相对有效性。方法：对1250例住院接受冠状动脉造影诊断的患者进行抑郁症状存在情况的问卷调查。每年对心脏病死亡率进行长达19.4年的跟踪调查。采用因子分析方法将Zung抑郁自评量表的条目分为四组：幸福感、负性情感、躯体和食欲。此外，920名患者对一项关于无望感的项目做出了回应。结果：幸福感和躯体症状显著预测生存(p<0.01)。负性情感项目也与生存相关(p=0.0001)，并与年龄存在交互作用。负性影响项的2-SD差异与50岁患者的相对风险1.29和年轻患者的1.70相关。在包含其他症状组的模型中，只有负面情绪仍然显著，绝望也预测存活，相对风险为1.5。在同一模型中，绝望感和负性情感两个项目仍然是独立的预测因素。所有模型都控制了疾病的严重程度和治疗。除了一个例外(收入和绝望)，对年龄、性别和收入的额外控制基本上没有改变结果。结论：抑郁症状对生存有不同的预测作用，其中抑郁情绪和绝望尤为重要。这些影响与疾病严重程度和躯体症状无关，在年轻患者中可能特别重要。
Objective: Multiple studies have shown that high levels of depressive symptoms increase the mortality risk of patients with established coronary disease. This investigation divided depressive symptoms into groups to assess their relative effectiveness in predicting survival, Methods: questionnaires about the presence of depressive symptoms were administered to 1250 patients with significant coronary disease while they were hospitalized for diagnostic coronary angiography. Follow-up for mortality due to cardiac disease was conducted annually for up to 19.4 years. Factor analysis was used to divide items on the Zung Self-Rating Depression Scale into four groups: Well-Being, Negative Affect, Somatic, and Appetite. In addition, responses to a single item regarding feelings of hopelessness were available for 920 patients. Results: Well-Being and Somatic symptoms significantly predicted survival (p less than or equal to .01). Negative Affect items were also related to survival (p = .0001) and interacted with age. A 2-SD difference in the Negative Affect term was associated with a relative risk of 1.29 for patients >50 years old and 1.70 for younger ones. Only Negative Affect remained significant in a model with the other symptom groups, Hopelessness also predicted survival with a relative risk of 1.5. Both the Hopelessness and Negative Affect items remained as independent predictors in the same model. All models controlled for severity of disease and treatment. With one exception (income and Hopelessness), results were essentially unchanged by additional controls for age, gender, and income. Conclusions: Depressive symptoms differentially predicted survival, with depressive affect and hopelessness being particularly important. These effects were independent of disease severity and somatic symptoms and may be especially important in younger patients.