Abstract

Background

Using a nationally representative sample of U.S. older adults (50+), this study investigates gender-based depression trajectories following heart disease onset and associated risk of disability and mortality over an 8-year period.

Method

Six waves of longitudinal data from the Health and Retirement Study (2006–2016) were used (n = 1787). Heart disease onset was defined as self-reporting no heart disease at baseline but reporting a positive diagnosis in a subsequent wave. Growth Mixture Modelling identified depression trajectories. Multinomial logistic regression models determined significant predictors of depression trajectories. Cox proportional-hazards models examined the associated disability and mortality risks.

Results

Three distinct depression trajectories were identified, including persistent minimal depression (men: 68.65%; women: 60.17%), moderate depression (women: 29.70%; men: 17.97%), and chronic depression (women: 10.12%) or emerging depression (men: 13.38%). Younger age and depression status at baseline were associated with women’s chronic depression and men’s emerging depression. Chronic/emerging and moderate depression were associated with higher disability risks than was minimal depression among both women and men (hazard ratios [HR] ranged from 2.12 to 3.92, p < 0.001). Only men’s emerging depression was linked to higher mortality risk compared to minimal depression (HR = 2.03, p < 0.001).

Conclusion

Longitudinal course of depression following onset of heart disease is heterogeneous in later life. Unfavorable depression trajectories (i.e. moderate, chronic, and emerging) were associated with higher disability risk compared to the minimal depression trajectory. Study findings characterize risk stratification regarding depression after heart disease onset, which can inform the development of interventions to improve health outcomes among older adults with heart conditions.

中文翻译：

---

心脏病发作后基于性别的抑郁轨迹：重要的预测因素和健康结果

摘要

背景

本研究使用具有全国代表性的美国老年人（50 岁以上）样本，调查了心脏病发作后基于性别的抑郁轨迹以及 8 年内相关的残疾和死亡风险。

方法

使用了来自健康和退休研究（2006-2016）的六波纵向数据（n  = 1787）。心脏病发作被定义为在基线时自我报告没有心脏病，但在随后的一波中报告为阳性诊断。生长混合模型确定了抑郁轨迹。多项逻辑回归模型确定了抑郁轨迹的重要预测因子。Cox 比例风险模型检查了相关的残疾和死亡风险。

结果

确定了三种不同的抑郁轨迹，包括持续性轻度抑郁（男性：68.65%；女性：60.17%）、中度抑郁（女性：29.70%；男性：17.97%）和慢性抑郁（女性：10.12%）或新发抑郁（男性：13.38%）。较年轻的年龄和基线时的抑郁状态与女性的慢性抑郁症和男性​​的新发抑郁症有关。在女性和男性中，慢性/新发和中度抑郁症的残疾风险高于轻度抑郁症（风险比 [HR] 范围为 2.12 至 3.92，p  < 0.001）。与轻度抑郁症相比，只有男性新出现的抑郁症与较高的死亡风险有关（HR = 2.03，p  < 0.001）。

结论

心脏病发作后抑郁的纵向病程在以后的生活中是异质的。与最小抑郁轨迹相比，不利的抑郁轨迹（即中度、慢性和新出现的）与更高的残疾风险相关。研究结果描述了心脏病发作后抑郁症的风险分层，这可以为干预措施的发展提供信息，以改善患有心脏病的老年人的健康结果。