Clinical factors associated with incident and persistent depression
among midlife Asian women: a longitudinal cohort study.
Abstract
Objective To identify modifiable risk factors in the
development and persistence of depression. Design Prospective
observational cohort study. Setting Healthy midlife women from
well-women clinics in a Singapore tertiary hospital enrolled from
September 2014 to October 2016. Population Enrolled
participants at baseline (n=1201) who were followed-up 6.6 years later.
Methods Sociodemographic characteristics and medical history
were collected using a questionnaire. Conditions such as urinary
incontinence and sleep quality were ascertained using validated
questionnaires, and physical performance was objectively-measured.
Changes in health conditions and physical performance measures were
calculated by subtracting baseline from follow-up values. Modified
Poisson regression analyses examined associations between risk factors
and outcomes. Main outcome measures Depressive symptoms were
defined using the Center for Epidemiological Studies-Depression (CES-D)
scale score ≥16 and/or use of anti-depression medication. Incident cases
were defined as new cases that emerged during follow-up, while
persistent cases were present at both timepoints. Results After
6.6 years, depression developed in 120 out of 741 (16.2%) participants,
while persistent depression was present in 34 out of 146 (23.3%) with
baseline depression. Urinary incontinence (adjusted relative risks, aRR:
1.51, 95% confidence interval, CI: 1.06-2.13), poorer perceived health
(1.78, 1.25-2.52), lower education attainment (1.72, 1.02-2.90), and
alcohol consumption (1.81, 1.11-2.96) at baseline were independently
associated with incident depression. Improvements in one-leg stand
duration over 6.6 years reduced the risk of incident depression (0.98,
0.96-0.99). Baseline poor sleep quality was a risk factor for both
incident and persistent depression. Conclusions Poor sleep,
urinary incontinence and weak physical performance are potentially
modifiable risk factors for incident and persistent depression.