医疗状况与后续重度抑郁障碍风险：一项基于登记册的全国性回顾性队列研究

Medical conditions and the risk of subsequent major depressive disorder: a nationwide, register-based, retrospective cohort study

——《柳叶刀/公共卫生》2025年5月9日，在线发布——

<The Lancet/Public Health> Published Online: May 9, 2025

【摘要】背景：重度抑郁障碍可能继发于疾病；然而，尚不清楚某些个体的风险是否高于其他个体。我们旨在对各种疾病发作后罹患重度抑郁障碍的风险进行全面评估。方法：这项全国性的、基于人群的回顾性队列研究纳入了1995年1月1日至2022年12月31日期间居住在丹麦的个体。在5年洗脱期内已患有其他疾病或重度抑郁障碍的个体被排除在外。疾病和重度抑郁障碍的信息来自丹麦国家登记处。暴露事件是指疾病发作，疾病定义为九大类疾病之一：循环系统疾病、内分泌系统疾病、肺部疾病、胃肠道疾病、泌尿生殖系统疾病、肌肉骨骼系统疾病、血液系统疾病、癌症和神经系统疾病。终点事件是重度抑郁障碍。采用校正后的Cox回归模型估算风险比 (HR)。采用竞争风险生存分析估算绝对风险。结果：共随访了6,528,353人，随访总时长为100,770,621人年。其中2,114,575人（32.4%）被诊断患有疾病，1,112,043人（17.0%）被诊断患有重度抑郁障碍。患有疾病的人患重度抑郁障碍的几率高于无疾病的人（HR 2.26，95% CI 2.25-2.28）。在出现疾病后的第一个月内，患重度抑郁障碍的HR为4.62（95% CI 4.50-4.74）。60岁及以上人群（HR 9.04，95% CI 8.63–9.47）、因疾病住院的患者（11.83，11.25–12.45）以及至少患有两种疾病的患者（8.92，8.74–9.11）中，疾病发作后头几个月的HR进一步升高。肌肉骨骼疾病导致的重度抑郁障碍HR最高（2.50，2.49–2.51），而内分泌疾病导致的重度抑郁障碍HR最低（1.35，1.34–1.36）。疾病发作10年后，重度抑郁障碍的HR为1.84（95% CI 1.82–1.86）。罹患疾病20年后，男性患重度抑郁障碍的绝对风险为18.9%（18.8-19.0%），女性为24.4%（24.3-24.5%），而匹配的无疾病男性为6.9%（6.8-7.0%），匹配的无疾病女性为10.7%（10.6-10.8%）。解读：罹患疾病与重度抑郁障碍风险升高相关，并且在确诊后立即升高，并且在特定亚群中风险会进一步升高。这些发现可用于早期发现，并在罹患疾病后关注特定群体。

[Summary] Background: Major depressive disorder can develop subsequent to medical conditions; however, it is unknown if some individuals are at higher risk than others. We aimed to provide comprehensive estimates for the risk of major depressive disorder subsequent to the onset of various medical conditions. Methods: In this nationwide, population-based, retrospective cohort study, individuals living in Denmark between Jan 1, 1995, and Dec 31, 2022, were included. Individuals who already had a medical condition or major depressive disorder within a 5-year washout period were excluded. Information on medical conditions and major depressive disorder was obtained from the National Danish Registries. The exposure was onset of medical conditions, defined as any of nine categories: circulatory, endocrine, pulmonary, gastrointestinal, urogenital, musculoskeletal, haematological, cancers, and neurological. The endpoint was major depressive disorder. Hazard ratios (HRs) were estimated with adjusted Cox regression models. Absolute risks were estimated with competing-risk survival analysis. Findings: 6,528,353 individuals were followed up for a total of 100,770, 621 person-years. 2,114,575 (32.4%) individuals were diagnosed with a medical condition and 1,112,043 (17.0%) individuals were diagnosed with major depressive disorder. Individuals with medical conditions had a higher rate of major depressive disorder than those without (HR 2.26, 95% CI 2.25–2.28). In the first month after onset of a medical condition, the HR for major depressive disorder was 4.62 (95% CI 4.50–4.74). The HR in the first months after onset of a medical condition was further elevated in individuals aged 60 years or older (HR 9.04, 95% CI 8.63–9.47), in patients hospitalised for a medical condition (11.83, 11.25–12.45), and in those with at least two medical conditions (8.92, 8.74–9.11). Musculoskeletal conditions had the highest HR for major depressive disorder (2.50, 2.49–2.51), whereas endocrine conditions had the lowest (1.35, 1.34–1.36). More than 10 years after onset of a medical condition the HR for major depressive disorder was 1.84 (95% CI 1.82–1.86). The absolute risk for major depressive disorder 20 years after onset of a medical condition was 18.9% (18.8–19.0) in men and 24.4% (24.3–24.5) in women compared with 6.9% (6.8–7.0%) in matched men without a medical condition and 10.7% (10.6–10.8%) in matched women without a medical condition. Interpretation: Onset of medical conditions is associated with an elevated risk of major depressive disorder and is further elevated immediately after diagnosis and in specific subgroups. These findings can be used for early detection and to give attention to specific groups in the period after onset of medical conditions.

论文原文：Per E Sigvardsen, Emil Fosbøl, Anders Jørgensen, et al. (2025). Medical conditions and the risk of subsequent major depressive disorder: a nationwide, register-based, retrospective cohort study. The Lancet/Public Health. Published Online: May 9, 2025.

https://doi.org/10.1016/S2468-2667(25)00073-8 

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