| 王现旺,袁卿惠,杜娟,陈亮,李丹,张晓培,田洋洋.中青年抑郁症状与脑卒中及全因死亡风险的关联[J].四川精神卫生杂志,2026,(3):246-254.Wang Xianwang,Yuan Qinghui,Du Juan,Chen Liang,Li Dan,Zhang Xiaopei,Tian Yangyang,Association between depressive symptoms and risk of stroke and all-cause mortality in young and middle-aged adults[J].SICHUAN MENTAL HEALTH,2026,(3):246-254 |
| 中青年抑郁症状与脑卒中及全因死亡风险的关联 |
| Association between depressive symptoms and risk of stroke and all-cause mortality in young and middle-aged adults |
| 投稿时间：2025-12-22 |
| DOI：10.11886/scjsws20251222003 |
| 中文关键词: 抑郁症状 脑卒中 全因死亡风险 美国国家健康和营养调查 中青年 |
| 英文关键词:Depressive symptoms Stroke All-cause mortality risk NHANES Young and middle-aged adults |
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| 背景 当前关于抑郁症状与脑卒中及全因死亡风险的研究多聚焦于老年群体或合并慢性病的高危人群。中青年人群的抑郁症状对脑卒中及全因死亡风险的长期影响仍缺乏系统评估，相关证据尚不充分。目的 探讨中青年人群抑郁症状与脑卒中及全因死亡风险的关联性，拓展该年龄段的风险证据，为早期识别高危人群及制定干预策略提供流行病学依据。方法 基于美国国家健康和营养调查（NHANES）数据库2009年—2018年的数据，纳入14 947名18~64岁的中青年受访者作为研究对象。使用Logistic回归及限制性立方样条（RCS）模型分析抑郁症状与脑卒中的相关性。采用Cox比例风险模型、RCS模型及绘制Kaplan-Meier（K-M）生存曲线，分析抑郁症状与全因死亡风险的关系。为验证主要结论的稳健性，按性别、高血压、糖尿病、高脂血症、体质量指数（BMI）及年龄分层进行敏感性分析。结果 Logistic回归分析显示，与无明显抑郁组相比，轻度抑郁组脑卒中患病风险增加53.50%（OR=1.535，95% CI：1.147~2.053），中重度抑郁组增加132.90%（OR=2.329，95% CI：1.733~3.129）。RCS分析显示，PHQ-9评分与脑卒中患病风险呈近似线性剂量-反应关系（Pfor non-linearity=0.089），随着PHQ-9评分升高，脑卒中患病风险呈上升趋势。Cox回归分析显示，与无明显抑郁组相比，轻度抑郁组全因死亡风险增加48.80%（HR=1.488，95% CI：1.164~1.902），中重度抑郁组增加70.60%（HR=1.706，95% CI：1.310~2.221）。RCS分析显示，PHQ-9评分与全因死亡风险呈线性剂量-反应关系（Pfor non-linearity=0.440）。K-M曲线提示，随着抑郁症状程度加重，全因死亡风险逐渐上升（P<0.05）。敏感性分析显示，抑郁症状与脑卒中及全因死亡风险的关系不受性别、高血压、糖尿病、高脂血症、BMI及年龄分层的影响，结论稳健。结论 在中青年人群中，轻度抑郁和中重度抑郁均与脑卒中及全因死亡风险升高相关，且中重度抑郁组的风险更高；抑郁症状与上述风险存在正向剂量-反应关系。 |
| 英文摘要: |
| Background Current studies on the relationship between depressive symptoms and the risks of stroke and all-cause mortality mostly focus on the elderly population or high-risk groups with chronic diseases. The long-term impact of depressive symptoms in young and middle-aged people on the risks of stroke and all-cause mortality still lacks systematic assessment， and the relevant evidence is insufficient.Objective To explore the association between depressive symptoms and the risks of stroke and all-cause mortality in young and middle-aged adults， thereby expanding the risk evidence in this age group and providing epidemiological basis for early identification of high-risk individuals and the development of targeted intervention strategies.Methods Based on data from the National Health and Nutrition Examination Survey （NHANES） database （2009–2018）， a total of 14 947 young and middle-aged respondents aged 18 to 64 were included as the research subjects. Logistic regression and restricted cubic spline （RCS） models were employed to examine the association between depressive symptoms and stroke. Cox proportional hazards model， RCS model， and Kaplan-Meier （K-M） survival curves were used to clarify the relationship between depressive symptoms and all-cause mortality risk. To verify the robustness of main findings， sensitivity analysis was conducted stratified by gender， hypertension， diabetes， hyperlipidemia， body mass index （BMI）， and age.Results Logistic regression analysis revealed that compared with the non-depressed group， the risk of stroke in the mild depression group increased by 53.50% （OR=1.535， 95% CI： 1.147–2.053）， while the moderate-to-severe depression group showed the highest risk with a 132.90% increase （OR=2.329， 95% CI： 1.733–3.129）. RCS analysis indicated an approximately linear dose-response relationship between PHQ-9 score and the risk of stroke （Pfor non-linearity=0.089）， with stroke risk increasing as PHQ-9 scores rose. As the PHQ-9 score increased， the risk of stroke also showed an upward trend. Cox regression analysis demonstrated that compared with the non-depressed group， the risk of all-cause mortality in the mild depression group increased by 48.80% （HR=1.488， 95% CI： 1.164–1.902）， and the moderate-to-severe depression group had a 70.60% increased risk （HR=1.706， 95% CI： 1.310–2.221）. RCS analysis showed a linear dose-response relationship between PHQ-9 scores and all-cause mortality risk （Pfor non-linearity=0.440）. K-M curves indicated that as the severity of depressive symptoms increases， the risk of all-cause mortality gradually rises （P<0.05）. Sensitivity analysis confirmed that the associations between depression symptoms and risks of stroke and all-cause mortality were not modified by gender， hypertension， diabetes， hyperlipidemia， BMI， or age， demonstrating robust findings.Conclusion Among the young and middle-aged population， both mild and moderate-to-severe depression were associated with increased risks of stroke and all-cause mortality， with the moderate-to-severe depression group showed more pronounced risk elevations. A positive dose-response relationship was observed between depressive symptoms and these risks. |
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