A prospective cohort study investigating factors associated with depression during medical internship.
A prospective cohort study investigating factors associated with depression during medical internship.
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DOI：
10.1001/archgenpsychiatry.2010.41
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发表时间：
2010-06
影响因子：
--
通讯作者：
Guille, Constance
中科院分区：
文献类型：
--
作者：
Sen, Srijan;Kranzler, Henry R.;Krystal, John H.;Speller, Heather;Chan, Grace;Gelernter, Joel;Guille, Constance
尽管医学实习生中抑郁症的患病率大大高于普通人群，但具体的原因还没有得到很好的理解。最近有报道称，5-羟色胺转运蛋白基因的遗传多态(5-HTTLPR)对生活压力引发抑郁的可能性有调节作用，这可能有助于理解医学实习生情绪症状的发展。确定与实习生抑郁相关的心理、人口统计学和住院医生计划因素，并以医学实习为模型，采用前瞻性的受试者内设计，解决早期研究的设计局限性，研究这种多态的调节作用。前瞻性队列研究13家美国医院740名参加实习计划的实习生在实习前使用患者健康问卷(PHQ-9)、一系列心理特征和5-HTTLPR基因来评估抑郁症状，然后在实习期间每隔3个月评估一次抑郁症状和潜在的压力源。PHQ-9抑郁评分从实习前的2.4分增加到实习期间的6.4分(p<；0.001)。符合PHQ-9抑郁症标准的参与者比例从实习前的3.9%上升到实习期间的平均25.7%(p<；0.001)。在实习前测量的一系列因素(女性、美国医学教育、困难的早期家庭环境、严重抑郁史、较低的基线抑郁症状评分和较高的神经质)以及在实习期间(增加工作时间、感觉到的医疗错误和紧张的生活事件)与实习期间抑郁症状的增加较大相关。此外，至少有一个转录水平较低的5-HTTLPR等位基因的受试者报告说，在实习压力下抑郁症状的增加更大(p=0.002)。在医学实习期间，抑郁症状明显增加。特定的个人、实习和遗传因素与抑郁症状的增加有关。
Although the prevalence of depression among medical interns substantially exceeds that of the general population, the specific factors responsible are not well understood. Recent reports of a moderating effect of a genetic polymorphism (5-HTTLPR) in the serotonin transporter protein gene on the likelihood that life stress will precipitate depression may help to understand the development of mood symptoms in medical interns. To identify psychological, demographic and residency program factors that associate with depression among interns and use medical internship as a model to study the moderating effects of this polymorphism using a prospective, within-subject design that addresses the design limitations of earlier studies. Prospective cohort study 13 United States hospitals 740 interns entering participating residency programs Subjects were assessed for depressive symptoms using the Patient Health Questionnaire (PHQ-9), a series of psychological traits and 5-HTTLPR genotype prior to internship and then assessed for depressive symptoms and potential stressors at 3-month intervals during internship. The PHQ-9 depression score increased from 2.4 prior to internship to a mean of 6.4 during internship (p<0.001). The proportion of participants who met PHQ-9 criteria for depression increased from 3.9% prior to internship to a mean of 25.7% during internship (p<0.001). A series of factors measured prior to internship (female sex, U.S. medical education, difficult early family environment, history of major depression, lower baseline depressive symptom score and higher neuroticism) and during internship (increased work hours, perceived medical errors and stressful life events) were associated with a greater increase in depressive symptoms during internship. In addition, subjects with at least one copy of a less transcribed 5-HTTLPR allele reported a greater increase in depressive symptoms under the stress of internship (p=0.002). There is a marked increase in depressive symptoms during medical internship. Specific individual, internship and genetic factors are associated with the increase in depressive symptoms.
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影响因子：
10.6
作者：
Kaufman, J;Yang, BZ;Gelernter, J
通讯作者：
Gelernter, J
影响因子：
5
作者：
COHEN, S;KAMARCK, T;MERMELSTEIN, R
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影响因子：
7.4
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1.9
作者：
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通讯作者：
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影响因子：
5.4
作者：
Baldwin, PJ;Dodd, M;Wrate, RM
通讯作者：
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