Association between Spirometric Parameters and Depressive Symptoms in New Mexico Uranium Workers.

Shiva Sharma, Xin W Shore, Satyajit Mohite, Orrin Myers, Denece Kesler, Kevin Vlahovich, Akshay Sood
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Abstract

Background: Uranium workers are at risk of developing lung disease, characterized by low forced expiratory volume in one second (FEV1) and/or forced vital capacity (FVC). Previous studies have found an association between decreased lung function and depressive symptoms in patients with pulmonary pathologies, but this association has not been well examined in occupational cohorts, especially uranium workers.

Methods: This cross-sectional study evaluated the association between spirometric measures and depressive symptoms in a sample of elderly former uranium workers screened by the New Mexico Radiation Exposure Screening & Education Program (NM-RESEP). Race- and ethnicity-specific reference equations were used to determine predicted spirometric indices (predictor variable). At least one depressive symptom [depressed mood and/or anhedonia, as determined by a modified Patient Health Questionnaire-2 (PHQ-2)], was the outcome variables. Chi-square tests and multivariable logistic regression models were used for statistical analyses.

Results: At least one depressive symptom was self-reported by 7.6% of uranium workers. Depressed mood was reported over twice as much as anhedonia (7.2% versus 3.3%). Abnormal FVC was associated with at least one depressive symptom after adjustment for covariates. There was no significant interaction between race/ethnicity and spirometric indices on depressive symptoms.

Conclusions: Although depressive symptoms are uncommonly reported in uranium workers, they are an important comorbidity due to their overall clinical impact. Abnormal FVC was associated with depressive symptoms. Race/ethnicity was not found to be an effect modifier for the association between abnormal FVC and depressive symptoms. To better understand the mechanism underlying this association and determine if a causal relationship exists between spirometric indices and depressive symptoms in occupational populations at risk for developing lung disease, larger longitudinal studies are required. We recommend screening for depressive symptoms for current and former uranium workers as part of routine health surveillance of this occupational cohort. Such screening may help overcome workers' reluctance to self-report and seek treatment for depression and may avoid negative consequences to health and safety from missed diagnoses.

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新墨西哥州铀矿工人肺活量测定参数与抑郁症状的关系
背景:铀工人有发生肺部疾病的危险,其特征是一秒钟用力呼气量(FEV1)和/或用力肺活量(FVC)低。先前的研究发现肺部病变患者的肺功能下降与抑郁症状之间存在关联,但这种关联尚未在职业队列中得到很好的检验,特别是铀工人。方法:本横断面研究评估了新墨西哥州辐射暴露筛查与教育计划(NM-RESEP)筛选的老年前铀工人样本中肺活量测量与抑郁症状之间的关系。使用种族和民族特异性参考方程来确定预测的肺活量指数(预测变量)。至少一种抑郁症状[抑郁情绪和/或快感缺乏,由修改后的患者健康问卷-2 (PHQ-2)确定]是结果变量。采用卡方检验和多变量logistic回归模型进行统计分析。结果:7.6%的铀矿工人自述至少有一种抑郁症状。抑郁情绪的报告是快感缺乏的两倍多(7.2%对3.3%)。校正协变量后,异常FVC与至少一种抑郁症状相关。种族/民族与肺量测定指标对抑郁症状没有显著的相互作用。结论:虽然抑郁症状在铀矿工人中很少报道,但由于其整体临床影响,它们是一种重要的合并症。FVC异常与抑郁症状相关。种族/民族未被发现是异常FVC与抑郁症状之间关联的影响调节因素。为了更好地理解这种关联背后的机制,并确定肺量测定指标与肺病高危职业人群抑郁症状之间是否存在因果关系,需要进行更大规模的纵向研究。我们建议对目前和以前的铀工人进行抑郁症状筛查,作为这一职业队列常规健康监测的一部分。这种筛查可能有助于克服工人不愿自我报告和寻求抑郁症治疗的情况,并可能避免漏诊对健康和安全造成的负面影响。
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