酒精使用與憂鬱症狀：老年世代之十年追蹤研究

Abstract

背景及目的：本研究採用一個老年世代十年追蹤的資料以探討酒精使用與憂鬱症狀發展之關係。方法：為一針對台灣60歲(含)以上老年人之前瞻性世代研究，受試者於家訪當中接受面對面的調查訪問，自1989年起間隔每三至四年即追蹤調查一次。酒精使用、社交活動之參與、健康情況、身體功能、及生活型態等皆於問卷訪視進行時詢問並紀錄，其中本研究之酒精使用採用目前飲酒狀態、飲酒頻率、以及平均每月飲酒量三個變項。憂鬱分數為使用Center for Epidemiologic Studies Depression (CES-D)問卷之評估結果。先前研究依前四波憂鬱分數(1989, 1993, 1996, 1999)的變化已將此老年世代之憂鬱變化分為四組：持續低分、持續中低分、後期高分、持續高分。本研究採用此憂鬱變化之分組情形為依變項，以多元邏輯迴歸分析(multinomial logistic regression analysis)探討酒精使用與憂鬱症狀發展的相關性。結果：男性、原住民或外省人、較為年輕之年齡族群、抽菸、較少的功能損失、以及較佳的自我健康評估者和基線調查時有飲酒行為相關。在基線調查時，雖然個別的勝算(odds)皆未達到統計上顯著意義，然可發現隨著憂鬱的嚴重度增加，其組內目前飲酒行為的勝算(odds)下降，由第二類(持續中低分)的1.03、第三類(後期高分)的0.89、至第四類(持續高分)的0.62。就飲酒頻率及每月飲酒量而言，酒精使用和輕度或中度憂鬱間可能存在非線性關係，其中第三類的後期高分憂鬱組每月飲用較少的酒精量之調整後勝算比達到統計上顯著意義(0.34)，相反地，第四類的持續高分憂鬱組之調整後勝算比則皆小於1。而就第二波的酒精使用而言，其和憂鬱發展分組的關係除了飲酒程度之非線性關係不復存在外，其結果型態大致上和基線調查的分析類似。結論：酒精使用程度較多和十年間較嚴重的憂鬱發展情形間沒有顯著的關係。就此飲酒程度相對較為節制的台灣老年世代而言，情緒較為穩定的人反而傾向於有酒精使用行為。酒精使用於這一個台灣老年世代可能意含著較佳的健康狀態及社交頻繁的生活型態。

Objectives: To examine the relations of alcohol consumption to the courses of depression in a 10-year follow-up elderly cohort in Taiwan. Methods: A prospective cohort study of the Taiwanese elderly people aged 60 and older was carried out since 1989. Participants were interviewed face-to-face during home visits and then were followed with intervals for every three to four years. Alcohol consumption, social activities, health conditions, physical functions and lifestyles were inquired and recorded. Alcohol consumption in our analyses included current drinking state, drinking frequency, and monthly drinking quantity. Depression was measured with the 10-item short form of Center for Epidemiologic Studies Depression (CES-D) scale. Grouping of depression course based on 10-item CES-D scores of the prior four waves (1989, 1993, 1996 and 1999) had been generated in previous research, and were groups with persistently low depression, persistently mild depression, late-peak depression, and high-chronic depression, respectively. The group assignment was used as the outcome variable in our study. Multinomial logistic regression analysis was applied to analyze the relations of alcohol consumption to grouping of depression course. Results: Current alcohol drinking at baseline was correlated with male gender, being aborigines or mainland Chinese, younger age group, tobacco smoking, less functional impairment, and better self-rated health. At baseline, as the severity of depression increased, the odds of alcohol consumption decreased from 1.03 for persistently mild depression to 0.89 for late-peak depression and 0.62 for high-chronic depression, though individual adjusted odds ratio (aOR) did not reach statistical significance. In terms of drinking frequency and monthly drinking quantity, there seemed to be non-linear relationships between levels of alcohol consumption and mild or moderated depression. Among these, the aOR of late-peak depression on less monthly drinking quantity reached statistical significance (0.34). In contrast, the aORs for high-chronic depression were consistently less than 1. At wave 2, similar patterns were found except the non-linear relations among mild to moderate depression course were no longer seen. Conclusions: More alcohol consumption was not associated with more severe course in depression during the 10 years follow-up. Instead, in the Taiwanese elderly cohort with relatively modest alcohol consumption, those with stable mood tend to drink alcohol. Alcohol consumption among the elderly may be the proxy of better healthy condition and more active, sociable lifestyles.