Excess mortality in depressive and anxiety disorders: The Lifelines Cohort Study

BackgroundTo examine the mortality risk of current and life-time depressive as well as anxiety disorders, whether this risk is moderated by sex or age, and whether this risk can be explained by lifestyle and/or somatic health status.MethodsA cohort study (Lifelines) including 141,377 participants (18–93 years) which were followed-up regarding mortality for 8.6 years (range 3.0–13.7). Baseline depressive and anxiety disorders according to Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria were assessed with the Mini International Neuropsychiatric Interview and lifetime diagnoses by self-report. All-cause mortality was retrieved from Statistics Netherlands. Cox-regression was applied to calculate proportional hazard ratios, adjusted for lifestyle (physical activity, alcohol use, smoking, and body mass index) and somatic health status (multimorbidity and frailty) in different models.ResultsThe mortality rate of depressive and anxiety disorders was conditional upon age but not on sex. Only in people below 60 years, current depressive and anxiety disorders were associated with mortality. Only depressive disorder and panic disorder independently predicted mortality when all mental disorders were included simultaneously in one overall model (hazard ratio [HR] = 2.18 [95% confidence intervals (CI): 1.56–3.05], p < 0.001 and HR = 2.39 [95% CI: 1.15–4.98], p = 0.020). Life-time depressive and anxiety disorders, however, were independent of each other associated with mortality. Associations hardly changed when adjusted for lifestyle characteristics but decreased substantially when adjusted for somatic health status (in particular physical frailty).ConclusionsIn particular, depressive disorder is associated with excess mortality in people below 60 years, independent of their lifestyle. This effect seems partly explained by multimorbidity and frailty, which suggest that chronic disease management of depression-associated somatic morbidity needs to be (further) improved.     

老年人身体功能对慢性病共病的影响

目的 探讨老年人身体功能对慢性病共病的影响。方法 采用中国健康与养老追踪调查数据库(CHARLS)的数据,以2011年基线调查的2 452名≥60岁的老年人为研究对象并追踪到2015年,调查内容包括握力、简易躯体能力(SPPB)、慢性病情况、人口学变量及健康行为变量等。采用SPSS 26.0统计软件进行数据分析。应用广义估计方程分析慢性病共病的影响因素,控制混杂因素后基于广义估计方程分析身体功能对慢性病共病的影响。结果 老年人慢性病共病患病率从2013年的48.9%(1 199/2 452)增加到2015年的56.1%(1 375/2 452),呈上升趋势。女性(OR=1.287,95%CI 1.124～1.474;P=0.000)、发生摔倒(OR=1.784,95%CI 1.560～2.040;P=0.000)、握力值较低及SPPB得分较低的老年人慢性病共病患病的风险较高。握力值以Q4为参照,Q1、Q2和Q3的风险为(OR=1.435,95%CI 1.213～1.698;P=0.000)、(OR=1.513,95%CI 1.287～1.780;P=0.000)和(OR=1.188,9...     

Prevalence and Correlates of Physical-mental Multimorbidity in Outpatient Children From a Pediatric Hospital in Canada

ObjectiveThe aim of this study was to estimate the six-month prevalence of mental illness in children with chronic physical illness (multimorbidity), examine agreement between parent and child reports of multimorbidity, and identify factors associated with child multimorbidity.MethodThe sample included 263 children aged 2–16 years with a physician-diagnosed chronic physical illness recruited from the outpatient clinics at a pediatric hospital. Children were categorized by physical illness according to the International Statistical Classification of Diseases and Related Health Problems (ICD)-10. Parent and child-reported six-month mental illness was based on the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID).ResultsOverall, 101 (38%) of children had a parent-reported mental illness; 29 (25%) children self-reported mental illness. There were no differences in prevalence across ICD-10 classifications. Parent-child agreement on the MINI-KID was low (κ = 0.18), ranging from κ = 0.24 for specific phobia to κ = 0.03 for attention-deficit hyperactivity. From logistic regression modeling (odds ratio [OR] and 95% confidence interval), factors associated with multimorbidity were: child age (OR = 1.16 [1.04, 1.31]), male (OR = 3.76 [1.54, 9.22]), ≥$90,000 household income (OR = 2.57 [1.08, 6.22]), parental symptoms of depression (OR = 1.09 [1.03, 1.14]), and child disability (OR = 1.21 [1.13, 1.30]). Similar results were obtained when modeling number of mental illnesses.ConclusionsFindings suggest that six-month multimorbidity is common and similar across different physical illnesses. Level of disability is a robust, potentially modifiable correlate of multimorbidity that can be assessed routinely by health professionals in the pediatric setting to initiate early mental health intervention to reduce the incidence of multimorbidity in children.     

Multimorbidity,functional impairment,and mortality in older patients stable after prior acute myocardial infarction: Insights from the TIGRIS registry

BackgroundData on the association of multimorbidity and functional impairment with cardiovascular (CV) and non‐CV outcomes among older myocardial infarction (MI) patients are limited.HypothesisMultimorbidity and functional impairment among older MI patients are associated with CV and non‐CV mortality.MethodsPatients aged ≥65 years, 1−3 years post‐MI, and enrolled between June 2013 and Novemeber 2014 from 349 sites in 25 countries in the global TIGRIS registry were categorized by age, number of comorbidities, and presence and degree of functional impairment. Functional impairment was calculated using five‐dimension EuroQol based on three domains—mobility, self‐care, and usual activities. The association between age, number of comorbid conditions, and degree of functional impairment with 2‐year incidence of CV and non‐CV death was evaluated using Poisson regression analysis.ResultsOlder age was associated with higher number of comorbidities and functional impairment; after adjustment, increasing age was significantly associated with non‐CV mortality (p = .03) but not CV mortality (p = .38). Greater functional impairment was associated with a higher rate and relatively equal magnitude risk of CV (rate ratios [RR] 1.52, 95% confidence intervals [CI]: 1.29−1.79, per one‐step increase) and non‐CV mortality (RR 1.42, 95% CI: 1.17−1.73). Multimorbidity was more strongly associated with CV mortality (RR 1.52, 95% CI: 1.38−1.67, per additional comorbidity) versus non‐CV mortality (RR 1.29, 95% CI: 1.14−1.47, per additional comorbidity).ConclusionsMultimorbidity and functional impairment are prevalent among older post‐MI patients and are associated with increased CV and non‐CV mortality. These findings highlight the importance of considering comorbid conditions and functional impairment as predictors of risk for adverse outcomes and aspects of medical decision making. Clinical Trial Registration: {"type":"clinical-trial","attrs":{"text":"NCT01866904","term_id":"NCT01866904"}}NCT01866904.     

油田企业一线员工慢性病共病患病率与劳动力健康损失调查

目的 了解油田员工慢性病患病情况,主要调查石油企业一线员工慢性病患病率、共病模式及健康损失。方法 2015年11-12月,深入长庆油田采油作业区现场,采用面对面访谈和问卷方式调查1 964名一线员工患病和健康损失情况,健康损失用患病持续时间（年）、EQ-5D指数得分、健康自评得分和长期服药比例表示,危险因素分析拟合logistic模型。结果 1 964名调查对象中,至少患有1种慢性病的765例（39.0%）,患有≥2种慢性病的303例（15.4%）,患有≥3种慢性病的139例（7.1%）;主要共病模式为高血压伴高血脂、高血压伴冠心病、骨质疏松伴高血脂、骨质疏松伴高血压、痛风伴高血压、糖尿病伴高血脂等;健康损失评价中慢性病患者EQ-5D指数得分和健康自评得分较低的主要有冠心病、痛风、肥胖症和风湿免疫疾病,24.4%的员工长期服药,其中48.7%为心血管药物;年龄、吸烟、饮酒、精神压力、睡眠质量等是慢性病发生的主要危险因素。结论 近半数油田员工受高血压、骨质疏松等慢性病及其共病的困扰,加强一线员工疾病预防和改进工作模式,提高企业劳动力健康,应受到企业健康管理者的高度重视。