Depressive symptoms during early adulthood and the development of physical multimorbidity in the UK: an observational cohort study.
Depressive symptoms during early adulthood and the development of physical multimorbidity in the UK: an observational cohort study.
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DOI：
10.1016/s2666-7568(21)00259-2
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发表时间：
2021-12
期刊：
影响因子：
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通讯作者：
Dregan A
中科院分区：
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作者：
Arias-de la Torre J;Ronaldson A;Prina M;Matcham F;Pinto Pereira SM;Hatch SL;Armstrong D;Pickles A;Hotopf M;Dregan A
了解早期抑郁症是否与身体多因素相关，可能有助于制定预防措施和抑郁症的综合管理。因此，我们的目的是绘制出成年期身体多Morphosis的累积发病率，并确定成年早期抑郁症状的存在与中年身体多Morphosis的发展之间的关联。在这项观察性队列研究中，我们使用了1958年国家儿童发育研究（NCDS）和1970年英国队列研究（BCS）的汇总数据。队列波被合并在每个十年的成年生活可用（当队列成员年龄在BCS中为26岁，在NCDS中为23岁[基线]; BCS中为34岁，在NCDS中为33岁[年龄34 BCS/33 NCDS]; BCS和NCDS中为42岁[年龄42 BCS/NCDS];以及在BCS中46岁和在NCDS中50岁[年龄46 BCS/50 NCDS]）。我们纳入的参与者在基线时完成了9项不适量表，并且没有身体多项障碍史，基线时没有任何身体多项障碍，或者在身体多项障碍发生之前没有抑郁症状。使用9项不适量表（临界评分≥4）确定是否存在抑郁症状。身体多Mortimorrhage被定义为至少有两个措施的任何以下10个自我报告组的长期条件：哮喘或支气管炎;背痛;膀胱或肾脏疾病;癌症;心血管疾病;惊厥或癫痫;糖尿病;听力条件;偏头痛;和胃，肠，或胆囊条件。计算基线后每10年的身体多发病累积发生率（95% CI），身体多发病作为二分变量和分类变量进行评估。采用校正的相对危险比（95%CI）评估抑郁症状与躯体多发病之间的关系。分析包括15845名参与者，其中4001人（25.25%; 95%CI 24.57 - 25.93）在基线时有抑郁症状，11844人（74.75%; 74.07 - 75.42）没有。 在研究期间，身体多重抑郁（二分）的累积发生率范围为34岁BCS/33岁NCDS的12273例参与者中的2263例（18.44%; 95%CI 17.75 - 18.14）至46岁BCS/50岁NCDS的10481例参与者中的4496例（42.90%; 41.95 - 43.85），并且在基线时有抑郁症状的参与者中始终较高。 有抑郁症状的受试者的躯体多项损伤的校正相对风险高于无抑郁症状的受试者，并且在研究期间保持稳定（34岁时BCS/33岁NCDS校正的相对率比为1.67，95%CI为1.50 ~ 1.87; 42岁时BCS/NCDS校正的相对率比为1.63，95%CI为1.48 ~ 1.79; 46岁BCS/50岁NCDS时为1·58、1·43-1·73）。在成年早期出现抑郁症状与中年时发生躯体多Morphia的风险增加有关。虽然需要进一步研究这种关系的驱动因素，但这些结果可能有助于加强对抑郁症状个体的综合管理，并制定预防策略，以减少身体多因素的影响和负担。英国医学研究理事会和盖伊慈善机构。
An understanding of whether early-life depression is associated with physical multimorbidity could be instrumental for the development of preventive measures and the integrated management of depression. We therefore aimed to map out the cumulative incidence of physical multimorbidity over adulthood, and to determine the association between the presence of depressive symptoms during early adulthood and the development of physical multimorbidity in middle age. In this observational cohort study, we used pooled data from the 1958 National Child Development Study (NCDS) and the 1970 British Cohort Study (BCS). Cohort waves were pooled in each decade of adult life available (when cohort members were aged 26 years in the BCS and 23 years in the NCDS [baseline]; 34 years in the BCS and 33 years in the NCDS [age 34 BCS/33 NCDS]; 42 years in the BCS and NCDS [age 42 BCS/NCDS]; and 46 years in the BCS and 50 years in the NCDS [age 46 BCS/50 NCDS]). We included participants who had completed the nine-item Malaise Inventory at baseline, and did not have a history of physical multimorbidity, any physical multimorbidity at baseline, or the presence of depressive symptoms before the development of physical multimorbidity. The presence of depressive symptoms was determined using the nine-item Malaise Inventory (cutoff score ≥4). Physical multimorbidity was defined as having at least two measures of any of the following ten self-reported groups of long-term conditions: asthma or bronchitis; backache; bladder or kidney conditions; cancer; cardiovascular conditions; convulsions or epilepsy; diabetes; hearing conditions; migraine; and stomach, bowel, or gall conditions. Cumulative incidence (with 95% CI) of physical multimorbidity was calculated for each decade considered after baseline, with physical multimorbidity being assessed as both a dichotomous and categorical variable. The association between depressive symptoms and the development of physical multimorbidity was assessed using adjusted relative risk ratios (with 95% CIs). Analyses included 15 845 participants, of whom 4001 (25·25%; 95% CI 24·57–25·93) had depressive symptoms at baseline and 11 844 (74·75%; 74·07–75·42) did not. The cumulative incidence of physical multimorbidity (dichotomous) ranged over the study period from 2263 (18·44%; 95% CI 17·75–18·14) of 12 273 participants at age 34 BCS/33 NCDS, to 4496 (42·90%; 41·95–43·85) of 10 481 participants at age 46 BCS/50 NCDS, and was consistently higher in participants with depressive symptoms at baseline. The adjusted relative risk of physical multimorbidity was higher in participants with depressive symptoms than in those without and remained stable over the study period (adjusted relative rate ratio 1·67, 95% CI 1·50–1·87, at age 34 BCS/33 NCDS; 1·63, 1·48–1·79, at age 42 BCS/NCDS; and 1·58, 1·43–1·73, at age 46 BCS/50 NCDS). The presence of depressive symptoms during early adulthood is associated with an increased risk of the development of physical multimorbidity in middle age. Although further research about the drivers of this relationship is needed, these results could help to enhance the integrated management of individuals with depressive symptoms and the development of preventive strategies to reduce the effect and burden of physical multimorbidity. UK Medical Research Council and Guy's Charity.