Depression and mortality in a longitudinal study: 1952-2011
Depression and mortality in a longitudinal study: 1952-2011
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DOI：
10.1503/cmaj.170125
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发表时间：
2017-10-23
影响因子：
14.6
通讯作者：
Colman, Ian
中科院分区：
文献类型：
--
作者：
Gilman, Stephen E.;Sucha, Ewa;Colman, Ian
背景：许多研究表明抑郁症会增加死亡风险。我们的目的是调查抑郁症与死亡风险增加相关的持续时间、抑郁症与死亡率之间相关性的长期趋势以及抑郁症与死亡率之间相关性的性别差异。方法：我们于1952年对加拿大大西洋沿岸一个县的3个代表性样本中的3410名成年人进行了队列研究（n = 1003），1970（n = 1203）或1992（n = 1402）（斯特林县研究）。使用基于抑郁情绪和相关症状的存在、持续时间超过1个月和实质性损害的诊断算法来测量抑郁。通过与加拿大死亡率数据库的概率联系，确定了2011年参与者的生命状态。在研究的3个时间段内，抑郁症与男性死亡风险增加相关，风险比（HR）为2.90（95%置信区间[CI] 1.69-4.98），1968 - 1990年为1.97（CI 1.34-2.89），1991 - 2011年为1.52（CI 1.09-2.13）。仅在1990年至2011年期间注意到女性死亡率风险升高（HR = 1.51; CI = 1.11-2.05）。解释：抑郁症和死亡率之间的关联持续了很长一段时间，并在近几十年中出现在女性中，尽管同期抑郁症治疗的改善和与抑郁症相关的耻辱感的减少。需要进一步研究，以更好地了解所涉及的机制。
BACKGROUND: Many studies have shown that depression increases mortality risk. We aimed to investigate the duration of time over which depression is associated with increased risk of mortality, secular trends in the association between depression and mortality, and sex differences in the association between depression and mortality.METHODS: We conducted a cohort study of 3410 adults enrolled in 3 representative samples of a county in Atlantic Canada in 1952 (n = 1003), 1970 (n = 1203) or 1992 (n = 1402) (the Stirling County Study). Depression was measured using a diagnostic algorithm based on the presence of depressed mood and associated symptoms, duration of more than 1 month, and substantial impairment. Vital status of participants through 2011 was determined using probabilistic linkages to the Canadian Mortality Database.RESULTS: Depression was associated with a heightened risk of mortality among men during the 3 time periods of the study, with hazard ratios (HRs) of 2.90 (95% confidence interval [CI] 1.69-4.98) between 1952 and 1967, 1.97 (CI 1.34-2.89) between 1968 and 1990, and 1.52 (CI 1.09-2.13) between 1991 and 2011. Elevated risk of mortality was noted among women only between 1990 and 2011 (HR = 1.51; CI = 1.11-2.05).INTERPRETATION: The association between depression and mortality persists over long periods of time and has emerged among women in recent decades, despite contemporaneous improvements in the treatment of depression and reduction of stigma associated with depression. Further research is needed to better understand the mechanisms involved.