醫療狀況與後續重度抑鬱障礙風險：一項基於登記冊的全國性回顧性隊列研究

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

——《柳葉刀/公共衛生》2025年5月9日，在線發布——

Published Online: May 9, 2025

【摘要】背景：重度抑鬱障礙可能繼發於疾病；然而，尚不清楚某些個體的風險是否高於其他個體。我們旨在對各種疾病發作後罹患重度抑鬱障礙的風險進行全面評估。方法：這項全國性的、基於人群的回顧性隊列研究納入了1995年1月1日至2022年12月31日期間居住在丹麥的個體。在5年洗脫期內已患有其他疾病或重度抑鬱障礙的個體被排除在外。疾病和重度抑鬱障礙的信息來自丹麥國家登記處。暴露事件是指疾病發作，疾病定義為九大類疾病之一：循環系統疾病、內分泌系統疾病、肺部疾病、胃腸道疾病、泌尿生殖系統疾病、肌肉骨骼系統疾病、血液系統疾病、癌症和神經系統疾病。終點事件是重度抑鬱障礙。採用校正後的Cox回歸模型估算風險比 (HR)。採用競爭風險生存分析估算絕對風險。結果：共隨訪了6,528,353人，隨訪總時長為100,770,621人年。其中2,114,575人（32.4%）被診斷患有疾病，1,112,043人（17.0%）被診斷患有重度抑鬱障礙。患有疾病的人患重度抑鬱障礙的幾率高於無疾病的人（HR 2.26，95% CI 2.25-2.28）。在出現疾病後的第一個月內，患重度抑鬱障礙的HR為4.62（95% CI 4.50-4.74）。60歲及以上人群（HR 9.04，95% CI 8.63–9.47）、因疾病住院的患者（11.83，11.25–12.45）以及至少患有兩種疾病的患者（8.92，8.74–9.11）中，疾病發作後頭幾個月的HR進一步升高。肌肉骨骼疾病導致的重度抑鬱障礙HR最高（2.50，2.49–2.51），而內分泌疾病導致的重度抑鬱障礙HR最低（1.35，1.34–1.36）。疾病發作10年後，重度抑鬱障礙的HR為1.84（95% CI 1.82–1.86）。罹患疾病20年後，男性患重度抑鬱障礙的絕對風險為18.9%（18.8-19.0%），女性為24.4%（24.3-24.5%），而匹配的無疾病男性為6.9%（6.8-7.0%），匹配的無疾病女性為10.7%（10.6-10.8%）。解讀：罹患疾病與重度抑鬱障礙風險升高相關，並且在確診後立即升高，並且在特定亞群中風險會進一步升高。這些發現可用於早期發現，並在罹患疾病後關注特定群體。

[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.

論文原文：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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