Increased mortality risk in women with depression and diabetes mellitus.
Increased mortality risk in women with depression and diabetes mellitus.
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DOI：
10.1001/archgenpsychiatry.2010.176
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发表时间：
2011-01
影响因子：
--
通讯作者：
Hu, Frank B.
中科院分区：
文献类型：
--
作者：
Pan, An;Lucas, Michel;Sun, Qi;van Dam, Rob M.;Franco, Oscar H.;Willett, Walter C.;Manson, JoAnn E.;Rexrode, Kathryn M.;Ascherio, Alberto;Hu, Frank B.
抑郁症和糖尿病都与全因和心血管疾病（CVD）死亡率的风险增加有关。然而，评估这两种情况对死亡率的联合影响的数据很少。在一项前瞻性队列研究中，评估抑郁症和糖尿病对全因死亡率和心血管疾病死亡率的个体和联合影响。在2000年基线时年龄在54-79岁的护士健康研究中，共有78282名女性参与者被随访至2006年。抑郁症被定义为自我报告诊断为抑郁症，使用抗抑郁药物治疗，或评分表明重度抑郁症，即，五项心理健康指数评分≤52。使用补充问卷确认自我报告的2型糖尿病。全因和CVD特异性死亡率。在6年的随访期间（433066人-年），记录了4654例死亡，包括979例CVD死亡。与没有任何一种疾病的参与者相比，年龄调整后的全因死亡率相对风险（95%置信区间，CI）仅为抑郁症女性1.76（1.64-1.89），仅为糖尿病患者1.71（1.54-1.89），两种疾病均为3.11（2.70-3.58）。相应的年龄校正CVD死亡率的相对危险度分别为1.81（1.54-2.13）、2.67（2.20-3.23）和5.38（4.19-6.91）。在对其他人口统计学变量、体重指数、吸烟状况、酒精摄入、体力活动和主要合并症进行多变量校正后，这些相关性减弱（包括高血压、高胆固醇血症、心脏病、中风和癌症），但仍然很显著，在这两种疾病的患者中，全因死亡率和心血管疾病死亡率的相对风险最高（分别为2.07 [95% CI，1.79-2.40]和2.72 [95% CI，2.09-3.54]）。此外，抑郁症与长期糖尿病的结合（即，>10年）或胰岛素治疗与多变量校正后CVD死亡率特别高的风险相关（相对风险分别为3.22和4.90）。抑郁症和糖尿病与全因和心血管疾病死亡风险显著增加相关。这两种情况的并存表明妇女的风险特别高。
Both depression and diabetes have been associated with an increased risk of all-cause and cardiovascular diseases (CVD) mortality. However, data evaluating the joint effects of these two conditions on mortality are sparse. To evaluate the individual and joint effects of depression and diabetes on all-cause and CVD mortality in a prospective cohort study. A total of 78282 female participants in the Nurses' Health Study aged 54-79 years at baseline in 2000 were followed until 2006. Depression was defined as having self-reported diagnosed depression, treatment with antidepressant medications, or a score indicating severe depressive symptomatology, i.e., a five-item Mental Health Index score ≤52. Self-reported type 2 diabetes was confirmed using a supplementary questionnaire. All-cause and CVD-specific mortality. During 6 years of follow-up (433066 person-years), 4654 deaths were documented, including 979 deaths from CVD. Compared to participants without either condition, the age-adjusted relative risks (95% confidence interval, CI) for all-cause mortality were 1.76 (1.64-1.89) for women with depression only, 1.71 (1.54-1.89) for individuals with diabetes only, and 3.11 (2.70-3.58) for those with both conditions. The corresponding age-adjusted relative risks of CVD mortality were 1.81 (1.54-2.13), 2.67 (2.20-3.23), and 5.38 (4.19-6.91), respectively. These associations were attenuated after multivariate adjustment for other demographic variables, body mass index, smoking status, alcohol intake, physical activity, and major comorbidities (including hypertension, hypercholesterolemia, heart diseases, stroke and cancer) but remained significant, with the highest relative risks for all-cause and CVD mortality found in those with both conditions (2.07 [95% CI, 1.79-2.40] and 2.72 [95% CI, 2.09-3.54], respectively). Furthermore, the combination of depression with a long duration of diabetes (i.e., >10 years) or insulin therapy was associated with particularly higher risk of CVD mortality after multivariate adjustment (relative risk=3.22 and 4.90, respectively). Depression and diabetes are associated with significantly increased risk of all-cause and CVD mortality. The coexistence of both conditions identifies particularly high-risk women.
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