Racial Variation in Depression Risk Factors and Symptom Trajectories among Older Women
Racial Variation in Depression Risk Factors and Symptom Trajectories among Older Women
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DOI：
10.1016/j.jagp.2016.07.008
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发表时间：
2016-11-01
影响因子：
7.2
通讯作者：
Okereke, Olivia I.
中科院分区：
文献类型：
--
作者：
Chang, Shun-Chiao;Wang, Wei;Okereke, Olivia I.
目的：评估老年妇女抑郁症危险因素和症状轨迹的种族差异。研究方法：使用护士健康研究数据，参与者（29，483名非西班牙裔白色和288名黑人女性）年龄在60岁或以上，在2000年没有抑郁症，直到2012年。关于种族和风险因素的数据，事先选择，从两年一次的问卷调查中获得。事件性抑郁症定义为抑郁症诊断、抗抑郁药使用或存在严重抑郁症状。基于组的抑郁症状的轨迹确定使用潜变量建模方法。结果如下：与白人相比，黑人参与者发生晚年抑郁症的风险较低（风险比：0.76; 95%置信区间：0.57-0.99）。虽然在研究基线时，黑人的某些风险因素的患病率高于白人，但晚年抑郁风险的主要贡献者（低运动，睡眠困难，身体/功能限制，疼痛）的分布是相似的。有证据表明，种族的影响修改的关系，出生地区（南方出生地），吸烟，和医疗合并症抑郁症的风险，但是，广泛的置信区间发生在黑人，因为样本量较小。确定了四个轨迹：最小阈值稳定（58.3%）、轻度阈值恶化（31.4%）、阈值下阈值恶化（4.8%）和阈值下阈值改善（5.5%）。黑人和白人的轨迹类型的概率相似。结论：尽管老年抑郁症状的总体轨迹在种族之间是可比的，但抑郁风险估计的种族差异与研究较少的因素有关，如美国和加拿大。S.出生地。未来的工作可能会解决未测量的健康和弹性决定因素，这些决定因素可能是观察到的结果的基础，并可能为晚年抑郁症风险因素的临床评估提供信息。
Objective: To assess racial variation in depression risk factors and symptom trajectories among older women. Methods: Using Nurses' Health Study data, participants (29,483 non-Hispanic white and 288 black women) aged 60 years or older, free of depression in 2000, were followed until 2012. Data on race and risk factors, selected a priori, were obtained from biennial questionnaires. Incident depression was defined as depression diagnosis, antidepressant use, or presence of severe depressive symptoms. Group-based trajectories of depressive symptoms were determined using latent variable modeling approaches. Results: Black participants had lower risk (hazard ratio: 0.76; 95% confidence interval: 0.57-0.99) of incident late-life depression compared with whites. Although blacks had higher prevalence than whites of some risk factors at study baseline, distributions of major contributors to late-life depression risk (low exercise, sleep difficulty, physical/functional limitation, pain) were comparable. There was evidence of effect modification by race for relations of region of birth (Southern birthplace), smoking, and medical comorbidity to depression risk; however, wide confidence intervals occurred among blacks because of smaller sample size. Four trajectories were identified: minimal symptoms-stable (58.3%), mild symptoms-worsening (31.4%), subthreshold symptoms-worsening (4.8%), and subthreshold symptoms-improving (5.5%). Probabilities of trajectory types were similar for blacks and whites. Conclusion: Although overall trajectories of late-life depressive symptoms were comparable by race, there was racial variation in depression risk estimates associated with less-studied factors, such as U. S. region of birth. Future work may address unmeasured health and resilience determinants that may underlie observed findings and that could inform clinical assessment of late-life depression risk factors.