The association of depression and mortality in elderly persons: A case for multiple, independent pathways
The association of depression and mortality in elderly persons: A case for multiple, independent pathways
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DOI：
10.1093/gerona/56.8.m505
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发表时间：
2001-08-01
影响因子：
5.1
通讯作者：
Pieper, CF
中科院分区：
文献类型：
--
作者：
Blazer, DG;Hybels, CF;Pieper, CF
背景抑郁症与社区老年人死亡率之间存在关联的证据仍然不确定，尽管在年轻人中这一点已经得到充分证实。现有的研究表明，当调整潜在的混杂因素，特别是功能障碍时，这种关联会减弱。对一组老年受试者进行3年随访分析，以确定抑郁症与3年死亡率之间的关系，并控制老年人群死亡率的主要已知危险因素。抑郁症（CES-D评分）、死亡率、人口统计学、体重指数、慢性病、吸烟史、认知障碍、功能障碍、自测健康和社会支持的信息来自社区居住老年人的分层概率样本，在北卡罗来纳州的皮埃蒙特的非裔美国人和白人之间平均分布。计算描述性统计量，并将Logistic回归用于一系列具有更多控制变量的模型。基线时抑郁症受试者在3年随访中未校正的相对死亡率为1.98。将年龄、性别和种族纳入模型并没有降低相对几率。当慢性疾病和健康习惯，认知障碍，功能障碍和社会支持被添加到模型中时，抑郁症死亡率的比值比分别为1.74，1.69，1.29和1.21。当增加其他变量时，模型中其他变量的比值比未出现下降。随着死亡的其他风险因素得到控制，抑郁症的估计死亡几率趋于一致。与其他已知的老年人死亡风险因素不同，抑郁症似乎通过许多独立的机制与死亡率相关，可能是通过复杂的反馈回路。
Background. The evidence for an association between depression and mortality among community-dwelling elderly persons remains inconclusive, although it is well established for younger individuals. Extant studies suggest that this association weakens when adjusted for potential confounding factors, especially functional impairment. A cohort of elderly subjects followed for 3 years was analyzed to determine the association of depression and 3-year mortality, controlling for the major known risk factors for mortality in the elderly population.Methods. Information on depression (CES-D scores), mortality, demographics, body mass index, chronic disease, smoking history, cognitive impairment, functional impairment, self-rated health, and social support was obtained from a stratified probability-based sample of community-dwelling elderly persons, with equal distribution between African Americans and whites in the Piedmont of North Carolina. Descriptive statistics were calculated, and logistic regression was used for a series of models with progressively more control variables.Results. The unadjusted relative odds of mortality among depressed subjects at baseline was 1.98 over 3 years of follow-up. Inclusion of age, gender, and race into the model did not reduce the relative odds. When chronic disease and health habits, cognitive impairment, functional impairment, and social support were added to the model, the odds ratios for mortality with depression were 1.74, 1.69, 1.29, and 1.21, respectively. This decrease in odds ratios was not observed for other variables in the model when additional variables were added.Conclusions. The estimated odds of dying if depressed moved toward unity as other risk factors for mortality were controlled. Unlike other known risk factors for mortality in the elderly population, depression appears to be associated with mortality through a number of independent mechanisms, perhaps through complex feedback loops.