Families at high and low risk for depression - A 3-generation study
Families at high and low risk for depression - A 3-generation study
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DOI：
10.1001/archpsyc.62.1.29
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发表时间：
2005-01-01
影响因子：
--
通讯作者：
Bruder, G
中科院分区：
文献类型：
--
作者：
Weissman, MM;Wickramaratne, P;Bruder, G
背景资料：早发性重性抑郁症（MDD）的家族性已在许多成人家庭研究中得到证实，并得到父母患有MDD的后代研究的支持，对他们来说，风险超过3倍。已发表的高风险研究均未超过2代，很少有纵向设计。我们报告了对抑郁症高风险和低风险家庭进行约20年随访的结果。在此期间，前两代人接受了4次采访。第二代的后代现在是成年人，并有自己的孩子，第三代的原始coherent.Objective：为了检查精神疾病的家族聚集性和功能，在孙子的父母和祖父母的抑郁状态。设计：纵向，回顾性队列，家庭研究。参与者：161个孙子和他们的父母和祖父母。主要结果措施：精神障碍和功能在孙辈中的终生发生率，按父母和祖父母抑郁状态分层，由临床医生收集，不知道前几代人的诊断和以前的访谈。两代患有抑郁症的孙辈中，精神障碍尤其是焦虑障碍的患病率较高，（平均年龄12岁）已经患有精神疾病。父母抑郁对孙辈结果的影响与祖父母抑郁状态显着不同。在祖父母患有抑郁症的家庭中，与父母没有抑郁症的孙辈相比，父母患有抑郁症的孙辈的焦虑风险增加（相对风险，5.17; 95%置信区间，1.4-18.7; P= 0.01），任何疾病的风险增加（相对风险，5.52; 95%置信区间，2.0-15.4; P= 0.002）。父母抑郁的严重程度，以损害来衡量，显着增加了这些孙子的情绪障碍的发生率（相对风险，2.44; 95%置信区间，1.1-5.5; P=.03）。相反，在患有非家族性抑郁症的孙辈中，即抑郁的父母没有抑郁的祖父母，父母的MDD对孙辈的诊断没有显著影响。然而，父母的抑郁症，无论家庭是否有抑郁的祖父母，对孙辈的整体功能有显着的影响。潜在的混杂变量并不影响与父母和祖父母抑郁症的关联强度。结论：父母抑郁症与儿童诊断之间的关联受到祖父母抑郁症状态的调节。患有中度至重度损害性抑郁症的父母和祖父母的孙辈的精神病理学发病率最高。焦虑症是年幼孙辈精神病理学的早期迹象。对患有中度至重度损害性MDD的两代人的后代进行早期干预似乎是必要的。这个家族性群体可能是神经影像学、遗传学和其他生物学研究的目标。
Background: The familial nature of early-onset major depressive disorder (MDD) has been documented in numerous family studies of adults and is supported by studies of offspring of parents with MDD, for whom the risk is more than 3-fold. None of the published high-risk studies have gone beyond 2 generations, and few have a longitudinal design. We report results of an approximately 20-year follow-up of families at high and low risk for depression. The first 2 generations were interviewed 4 times during this period. The offspring from the second generation are now adults and have children of their own, the third generation of the original cohort.Objective: To examine the familial aggregation of psychiatric disorders and functioning in grandchildren by their parents' and grandparents' depression status.Design: Longitudinal, retrospective cohort, family study.Participants: One hundred sixty-one grandchildren and their parents and grandparents.Main Outcome Measures: Lifetime rate of psychiatric disorder and functioning in grandchildren, stratified by parental and by grandparental depression Status, collected by clinicians blind to diagnoses of previous generations and to previous interviews.Results: There were high rates of psychiatric disorders, particularly anxiety disorders, in the grandchildren with 2 generations of major depression, with 59.2% of these grandchildren (mean age, 12 years) already having a psychiatric disorder. The effect of parental depression on grandchildren's outcomes differed significantly with grandparental depression status. Among families with a depressed grandparent, increased risk of anxiety (relative risk, 5.17; 95% confidence interval, 1.4-18.7; P=.01) and increased risk of any disorder (relative risk, 5.52; 95% confidence interval, 2.0-15.4; P=.002) were observed in grandchildren with a depressed parent as compared with those with nondepressed parents. The severity of parental depression, as measured by impairment, significantly increased the rate of a mood disorder in these grandchildren (relative risk, 2.44; 95% confidence interval, 1.1-5.5; P=.03). In contrast, among grandchildren with non-familial depression, ie, depressed parents with no depressed grandparents, there was no significant effect of parental MDD on grandchildren diagnoses. However, parental MDD, regardless of whether families had a depressed grandparent, had a significant impact on the grandchildren's overall functioning. Potential confounding variables did not affect the strength of the association with parental and grandparental depression.Conclusions: The association between parental MDD and child diagnosis is moderated by grandparental MDD status. The rates of psychopathology are highest in grandchildren of parents and grandparents with a moderately to severely impairing depression. Anxiety disorders are the early sign of psychopathology in the young grandchildren. Early interventions in the offspring of 2 generations affected with moderately to severely impairing MDD seem warranted. This familial group may be the target for neuroimaging, genetic, and other biological studies.