Depression without sadness: Functional outcomes of nondysphoric depression in later life
Depression without sadness: Functional outcomes of nondysphoric depression in later life
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DOI：
10.1111/j.1532-5415.1997.tb03089.x
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发表时间：
1997-05-01
影响因子：
6.3
通讯作者：
Anthony, JC
中科院分区：
文献类型：
--
作者：
Gallo, JJ;Rabins, PV;Anthony, JC
评论：我们假设，在13年的随访期间，不符合重度抑郁症标准的抑郁症状与老年人的显著功能障碍相关。具体来说，我们制定了一种抑郁症的标准，其核心症状不包括悲伤或烦躁。设计：以人群为基础的13年随访调查。设置：1981年居住在东巴尔的摩的社区居住成年人。参与者：受试者是巴尔的摩流行病学集水区项目样本中的1612名参与者，年龄在50岁及以上，1981.测量：受试者根据他们在基线时的反应分为四类：（1）符合重度抑郁症标准标准的人;（2）符合抑郁症伴烦躁或（3）不伴烦躁的替代标准的人;（4）不符合任何抑郁症标准的人（“非病例”）。在13年的随访间隔后，对各组的死亡率和功能状态进行了比较。结果：与非病例相比，年龄在50岁及以上的参与者报告了抑郁症状，但否认悲伤或烦躁（非焦虑性抑郁症）的死亡风险增加（相对风险（RR）= 1.70; 95%置信区间（CI）（1.09，2.67）），日常生活活动障碍（RR = 3.76; 95% CI（1.73，8.14）），工具性日常生活活动受损（RR = 5.07; 95%CI（2.24，11.44））、心理困扰（RR = 3.68; 95%CI（1.47，9.21））和认知障碍（RR = 3.00; 95%CI（1.31，6.89））13年随访间隔后。调查结果并没有完全解释的潜在影响的基线特征，如年龄，教育，选择共病的医疗条件，和功能status.CONCLUSION：在50岁及以上的成年人，非烦躁抑郁症可能是重要的抑郁症的发展功能障碍和其他长期的结果。
OBJECTVES: We hypothesized that depressive symptoms not meeting full standard criteria for Major Depression would be associated with significant functional impairment among older adults over the course of a 13-year follow-up interval. Specifically, we developed criteria for a form of depression whose core symptoms did not include sadness or dysphoria.DESIGN: Population-based 13-year follow-up survey.SETTING: Community-dwelling adults living in East Baltimore in 1981.PARTICIPANTS: Subjects were the 1612 participants of the Baltimore sample of the Epidemiologic Catchment Area Program aged 50 years and older at the initial interview in 1981.MEASUREMENTS: The subjects were sorted into four categories based on their responses at baseline: (1) persons meeting standard criteria for Major Depression; (2) persons meeting alternative criteria for depression with dysphoria or (3) without dysphoria; and (4) a comparison category of persons not meeting any criteria for depression (''noncases''). The mortality and functional status of each group were compared after a 13-year follow-up interval.RESULTS: Compared with non-cases, participants aged 50 years and older who reported depressive symptoms but who denied sadness or dysphoria (nondysphoric depression) were at increased risk for death (relative risk (RR) = 1.70; 95% confidence interval (CI) (1.09, 2.67)), impairment in activities of daily living (RR = 3.76; 95% CI (1.73, 8.14)), impairment in instrumental activities of daily living (RR = 5.07; 95% CI (2.24, 11.44)), psychologic distress (RR = 3.68; 95% CI (1.47, 9.21)), and cognitive impairment (RR = 3.00; 95% CI (1.31, 6.89)) after a 13-year follow-up interval. The findings were not wholly explained by potentially influential baseline characteristics such as age, education, selected comorbid medical conditions, and functional status.CONCLUSION: Among adults aged 50 years and older, nondysphoric depression may be as important as Major Depression in relation to the development of functional disability and other long-term outcomes.