Differences in early childhood risk factors for juvenile-onset and adult-onset depression
Differences in early childhood risk factors for juvenile-onset and adult-onset depression
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DOI：
10.1001/archpsyc.59.3.215
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发表时间：
2002-03-01
影响因子：
--
通讯作者：
Martin, J
中科院分区：
文献类型：
--
作者：
Jaffee, SR;Moffitt, TE;Martin, J
背景：家族和双胞胎研究表明，青少年起病的重度抑郁障碍(MDD)可能与成人起病的MDD在病因上是不同的。这项研究首次对从童年到成年的代表性出生队列中的青少年和成人发病病例进行了前瞻性区分。方法：这项研究前瞻性地跟踪了从出生到26岁的代表性出生队列。儿童早期危险因素涵盖从出生到9岁。MDD的诊断依据DSM标准，成年前3分(11、13、15岁)，成年3分(18、21、26岁)。共分为4组：(1)儿童时期首次诊断为MDD的个体(n=21)；(2)成年后首次诊断为MDD的个体(n=314)；(3)儿童时期首次诊断为MDD的个体(n=34)；(4)从未患抑郁症的个体(n=629)。与成年抑郁症组相比，青少年起病组经历了更多的围产期侮辱和运动技能缺陷，家庭中的照顾者不稳定，犯罪和精神病理，以及行为和社会情绪问题。除儿童期性虐待增多外，成年组与非抑郁组的风险分布相似。结论：精神疾病患者群体内的异质性给理论、研究和治疗带来了问题。目前的研究表明，青少年和成人发病的MDD之间的区别对于理解抑郁症的异质性很重要。
Background: Family and twin studies suggest that juvenile-onset major depressive disorder (MDD) may be etiologically distinct from adult-onset MDD. This study is the first to distinguish prospectively between juvenile- and adult-onset cases of MDD in a representative birth cohort followed up from childhood into adulthood.Method: The study followed a representative birth cohort prospectively from birth to age 26 years. Early childhood risk factors covered the period from birth to age 9 years. Diagnoses of MDD were made according to DSM criteria at 3 points prior to adulthood (ages 11, 13, and 15 years) and 3 points during adulthood (ages 18,21, and 26 years). Four groups were defined as (1) individuals first diagnosed as having MDD in childhood, but not in adulthood (n= 21); (2) individuals first diagnosed as having MDD in adulthood (n=314); (3) individuals first diagnosed in childhood whose depression recurred in adulthood by age 26 years (n=34); and (4) never-depressed individuals (n = 629).Results: The 2 juvenile-onset groups had similar high-risk profiles on the childhood measures. Compared with the adult-depressed group, the juvenile-onset groups experienced more perinatal insults and motor skill deficits, caretaker instability, criminality, and psychopathology in their family-of-origin, and behavioral and socioemotional problems. The adult-onset group's risk profile was similar to that of the never-depressed group with the exception of elevated childhood sexual abuse.Conclusions: Heterogeneity within groups of psychiatric patients poses problems for theory, research, and treatment. The present study illustrates that the distinction between juvenile- vs adult-onset MDD is important for understanding heterogeneity within depression.