Depressive symptoms in spouses of older patients with severe sepsis.
Depressive symptoms in spouses of older patients with severe sepsis.
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DOI：
10.1097/ccm.0b013e3182536a81
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发表时间：
2012-08
影响因子：
8.8
通讯作者：
Iwashyna TJ
中科院分区：
文献类型：
--
作者：
Davydow DS;Hough CL;Langa KM;Iwashyna TJ
为了研究严重脓毒症患者的配偶患抑郁症的风险是否增加，与配偶的败血症前病史无关，这种风险是否因性别而不同，并与脓毒症患者住院后的残疾有关。前瞻性纵向队列研究。作为健康和退休研究(1993-2008)的一部分，对50岁以上的美国成年人进行了基于人口的队列采访。929名患者-配偶二人组，其中1212人因严重脓毒症住院。在医疗保险索赔中，使用经过验证的算法确定了严重的脓毒症。用改良版的流行病学研究中心抑郁量表评估抑郁症。所有的分析都按性别分层。在多变量回归分析中，严重脓毒症患者的妻子出现实质性抑郁症状的比例在严重脓毒症时增加了14个百分点(从感染前1.1年的中位数20%增加到感染后1年的中位数34%)，优势比(OR)为3.74(95%可信区间[CI]：2.20，6.37)。丈夫的抑郁症状发生率增加了8个百分点，经多因素回归分析，差异无统计学意义(OR1.90，95%CI：0.75，4.71)。丧亲不能解释抑郁症的增加；即使配偶在严重的脓毒症住院期间幸存下来，女性出现实质性抑郁症状的几率也更大(OR 2.86，95%CI 1.06，7.73)。残废的脓毒症幸存者的妻子更容易抑郁(OR1.35/ADL限制，95%CI：1.12，1.64)；然而，控制患者残疾仅轻微减弱脓毒症与妻子抑郁之间的关联(OR 2.61，95%CI：0.93，7.38)。如果她们的配偶因严重的脓毒症而住院，老年女性患抑郁症的风险可能会更大。严重脓毒症患者的配偶可能会从更多的支持和抑郁筛查中受益，无论是当他们的亲人去世时，还是当他们的亲人幸存时。
To examine whether spouses of patients with severe sepsis are at increased risk for depression independent of the spouse’s pre-sepsis history, whether this risk differs by sex, and is associated with a sepsis patient’s disability after hospitalization. Prospective longitudinal cohort study. Population-based cohort of U.S. adults over 50 years old interviewed as part of the Health and Retirement Study (1993–2008). 929 patient-spouse dyads comprising 1,212 hospitalizations for severe sepsis. Severe sepsis was identified using a validated algorithm in Medicare claims. Depression was assessed with a modified version of the Center for Epidemiologic Studies Depression Scale. All analyses were stratified by gender. The prevalence of substantial depressive symptoms in wives of patients with severe sepsis increased by 14 percentage points at the time of severe sepsis (from 20% at a median of 1.1 years pre-sepsis to 34% at a median of 1 year post-sepsis), an odds ratio (OR) of 3.74 (95% Confidence Interval [CI]: 2.20, 6.37), in multivariable regression. Husbands had an 8 percentage point increase in the prevalence of substantial depressive symptoms, which was not significant in multivariable regression (OR 1.90, 95%CI: 0.75, 4.71). The increase in depression was not explained by bereavement; women had greater odds of substantial depressive symptoms even when their spouse survived a severe sepsis hospitalization (OR 2.86, 95%CI 1.06, 7.73). Wives of sepsis survivors who were disabled were more likely to be depressed (OR 1.35 per ADL limitation of sepsis survivor, 95%CI: 1.12, 1.64); however, controlling for patient disability only slightly attenuated the association between sepsis and wives’ depression (OR 2.61, 95%CI: 0.93, 7.38). Older women may be at greater risk for depression if their spouse is hospitalized for severe sepsis. Spouses of patients with severe sepsis may benefit from greater supports and depression screening, both when their loved one dies, but also when their loved one survives.