Depression is more than the sum score of its parts: individual DSM symptoms have different risk factors
Depression is more than the sum score of its parts: individual DSM symptoms have different risk factors
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DOI：
10.1017/s0033291713002900
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发表时间：
2014-07-01
影响因子：
6.9
通讯作者：
Sen, S.
中科院分区：
文献类型：
--
作者：
Fried, E. I.;Nesse, R. M.;Sen, S.
背景出于诊断目的，构成DSM-5重度抑郁症（MDD）标准的9种症状被假定为一种潜在疾病的可互换指标，这意味着它们都应该具有相似的风险因素。本研究调查了这一假设，使用的人群队列，从低到高抑郁水平的转变。我们评估了9个DSM-5 MDD标准症状（使用患者健康问卷; PHQ-9）和7个抑郁症风险因素（个人和家族MDD史，性别，儿童期压力，神经质，工作时间，和紧张的生活事件）在纵向研究的医学实习生之前和整个实习（n= 1289）。我们测试了不同症状的危险因素是否不同，以及潜伏性疾病模型是否可以解释不同症状之间的异质性。住院医师培训期间，所有MDD症状均显著增加。四个风险因素预测了PHQ-9症状的独特子集随时间的推移而增加（抑郁症史，童年压力，性别和压力性生活事件），而神经质和工作时间预测了所有症状的增加，尽管幅度不同。MDD家族史不能预测任何症状的增加。在控制了一个潜在的抑郁因素后，这种关联的强烈异质性仍然存在。危险因素的影响在DSM抑郁症标准症状中差异很大。由于症状在病因上是异质的，除了抑郁症诊断外，还考虑个体症状可能会提供被症状总和分数混淆的重要见解。
Background. For diagnostic purposes, the nine symptoms that compose the DSM-5 criteria for major depressive disorder (MDD) are assumed to be interchangeable indicators of one underlying disorder, implying that they should all have similar risk factors. The present study investigates this hypothesis, using a population cohort that shifts from low to elevated depression levels.Method. We assessed the nine DSM-5 MDD criterion symptoms (using the Patient Health Questionnaire; PHQ-9) and seven depression risk factors (personal and family MDD history, sex, childhood stress, neuroticism, work hours, and stressful life events) in a longitudinal study of medical interns prior to and throughout internship (n= 1289). We tested whether risk factors varied across symptoms, and whether a latent disease model could account for heterogeneity between symptoms.Results. All MDD symptoms increased significantly during residency training. Four risk factors predicted increases in unique subsets of PHQ-9 symptoms over time (depression history, childhood stress, sex, and stressful life events), whereas neuroticism and work hours predicted increases in all symptoms, albeit to varying magnitudes. MDD family history did not predict increases in any symptom. The strong heterogeneity of associations persisted after controlling for a latent depression factor.Conclusions. The influence of risk factors varies substantially across DSM depression criterion symptoms. As symptoms are etiologically heterogeneous, considering individual symptoms in addition to depression diagnosis might offer important insights obfuscated by symptom sum scores.