慢性疾病和控制水平在抑郁过程中的相互作用。

IF 3.5 2区医学 Q2 PSYCHIATRY

Journal of Psychosomatic Research Pub Date : 2025-02-01 DOI:10.1016/j.jpsychores.2024.112000

Delphine A. Ambe , Richard C. Oude Voshaar , Radboud M. Marijnissen , Heidi de Kam , Nathaly Rius-Ottenheim , Almar A.L. Kok , Didi Rhebergen

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引用次数: 0

摘要

背景：慢性疾病可能会对抑郁症的病程产生负面影响。我们的目的是研究慢性疾病与抑郁症病程之间的关系是否会受到掌握程度的调节：方法：对 1146 名年龄在 18-88 岁之间、根据 DSM-IV 标准患有抑郁症的人进行为期两年的跟踪调查。研究结果包括抑郁严重程度的变化（IDS-SR变化）（945人）、慢性病程（病历访谈）（971人）、随访时的抑郁（DSM诊断）（971人）和缓解时间（病历访谈）（799人）。预测因素为慢性躯体疾病的数量和掌握程度。使用回归模型（线性、逻辑和 Cox），并对抑郁严重程度、社会人口统计学、孤独、吸烟和酗酒进行调整。然后，在模型中加入交互项（慢性疾病*掌握程度）：结果：当结果定义为抑郁严重程度的变化时，我们只发现掌握程度与慢性疾病之间存在明显的交互作用（p = 0.02）。在根据掌握程度进行的分层分析中，掌握程度中等（B=1.03；P=0.03）和掌握程度高（B=1.10；P=0.02）的人的慢性病与慢性病程有显著关联。在未分层分析中，掌握程度与慢性病程（B = -0.18，p = 0.03）和缓解时间（B = 1.03；p 结论：虽然慢性病对抑郁症的发展轨迹有影响，但掌握程度与慢性病的发展轨迹并不相关：虽然慢性疾病对抑郁轨迹的影响不如预期的那么一致，但如果存在这种关联，则会受到掌握程度的调节，这表明掌握程度较高的人可能难以应对躯体疾病。在临床实践中，有必要关注躯体疾病和应对策略对掌握程度较高者的影响。

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Interaction of chronic diseases and levels of mastery on the course of depression

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Interaction of chronic diseases and levels of mastery on the course of depression

Background

Chronic diseases may negatively interfere with the course of depression. Our aim was to examine whether the association between chronic disease and course of depression is moderated by mastery.

Method

N = 1146 persons, aged 18–88, with depressive disorder according to DSM-IV criteria were followed for two years. Outcomes were change in depression severity (change in IDS-SR) (n = 945), chronic course (life chart interview) (n = 971), depression at follow-up (DSM-diagnosis) (n = 971), and time to remission (life chart interview) (n = 799). Predictors were number of chronic somatic diseases and mastery. Regression models (linear, logistic and Cox) were used, adjusted for depression severity, sociodemographics, loneliness, smoking and alcohol use. Next, an interaction term (chronic diseases*mastery) was added to the models.

Results

We only found significant interaction between mastery and chronic diseases (p = 0.02), when outcome was defined as change in depression severity. In analyses, stratified for level of mastery, chronic diseases were significantly associated with chronic course in persons with moderate (B = 1.03; p = 0.03) and high (B = 1.10; p = 0.02) mastery levels. In unstratified analyses, mastery was associated with both chronic course (B = -0.18, p = 0.03) and time to remission (B = 1.03; p < 0.001). Chronic diseases did not reach significance in three outcomes.

Conclusion

While impact of chronic diseases on depression trajectories was less consistent than expected, when present, this association was moderated by mastery, suggesting that persons with higher levels of mastery may have difficulties coping with somatic illnesses. In clinical practice, attention to the impact of somatic diseases and coping strategies, in persons with higher levels of mastery, is warranted.

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来源期刊

Journal of Psychosomatic Research 医学-精神病学

CiteScore

7.40

自引率

6.40%

发文量

314

审稿时长

6.2 weeks

期刊介绍： The Journal of Psychosomatic Research is a multidisciplinary research journal covering all aspects of the relationships between psychology and medicine. The scope is broad and ranges from basic human biological and psychological research to evaluations of treatment and services. Papers will normally be concerned with illness or patients rather than studies of healthy populations. Studies concerning special populations, such as the elderly and children and adolescents, are welcome. In addition to peer-reviewed original papers, the journal publishes editorials, reviews, and other papers related to the journal''s aims.