使用消费者可穿戴设备研究抑郁症诊断前的身体活动轨迹：病例对照研究
Physical Activity Trajectories Preceding Incident Major Depressive Disorder Diagnosis Using Consumer Wearable Devices in the All of Us Research Program: Case-Control Study
AI总结：
本研究利用可穿戴设备分析抑郁症诊断前的身体活动轨迹，发现持续下降的活动水平在诊断前几个月出现，提示早期监测对风险分层和干预的重要性。
摘要：
低体力活动是抑郁症的主要风险因素，但诊断前活动的变化仍不清楚，尤其是使用长期客观测量。本研究通过All of Us研究计划中的电子健康记录和Fitbit数据，回顾性地进行了嵌套病例对照研究。在诊断前至少有6个月有效可穿戴数据的成年人符合入选标准。病例按年龄、性别、体重指数和索引时间与对照匹配（每个病例最多匹配四个对照）。每日步数和中等至高强度体力活动（MVPA）被汇总为月平均值。线性混合效应模型比较了诊断前12个月到诊断期间的轨迹。在病例中，对比分析确定了活动首次显著偏离12个月前水平的时间。研究队列包括4104名参与者（829名病例和3275名对照；81.7%为女性；中位年龄48.4岁）。与对照相比，病例在诊断前一年的活动水平持续较低，步数和MVPA的显著下降轨迹在诊断前4个月和5个月出现（P < 0.001）。探索性分析表明存在亚组差异，包括男性下降更陡、老年人强度减少更大，以及肥胖者持续低活动水平。持续的个体体力活动下降在抑郁症诊断前几个月出现。纵向可穿戴监测可能为风险分层和早期干预提供早期信号。
英文摘要：
Low physical activity is a known risk factor for major depressive disorder (MDD), but changes in activity before a first clinical diagnosis remain unclear, especially using long-term objective measurements. This study characterized trajectories of wearable-measured physical activity during the year preceding incident MDD diagnosis. We conducted a retrospective nested case-control study using linked electronic health record and Fitbit data from the All of Us Research Program. Adults with at least 6 months of valid wearable data in the year before diagnosis were eligible. Incident MDD cases were matched to controls on age, sex, body mass index, and index time (up to four controls per case). Daily step counts and moderate-to-vigorous physical activity (MVPA) were aggregated into monthly averages. Linear mixed-effects models compared trajectories from 12 months before diagnosis to diagnosis. Within cases, contrasts identified when activity first significantly deviated from levels 12 months prior. The cohort included 4,104 participants (829 cases and 3,275 controls; 81.7% women; median age 48.4 years). Compared with controls, cases showed consistently lower activity and significant downward trajectories in both step counts and MVPA during the year before diagnosis (P < 0.001). Significant declines appeared about 4 months before diagnosis for step counts and 5 months for MVPA. Exploratory analyses suggested subgroup differences, including steeper declines in men, greater intensity reductions at older ages, and persistently low activity among individuals with obesity. Sustained within-person declines in physical activity emerged months before incident MDD diagnosis. Longitudinal wearable monitoring may provide early signals to support risk stratification and earlier intervention.
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