The role and clinical significance of subsyndromal depressive symptoms (SSD) in unipolar major depressive disorder
The role and clinical significance of subsyndromal depressive symptoms (SSD) in unipolar major depressive disorder
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DOI：
10.1016/s0165-0327(97)00055-4
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发表时间：
1997-08-01
影响因子：
6.6
通讯作者：
Paulus, MP
中科院分区：
文献类型：
--
作者：
Judd, LL;Akiskal, HS;Paulus, MP
在NIMH流行病学集水区（EGA）项目调查的10526名社区受访者中进行的分析显示，在第一次ECA访谈（第1波）时，一般人群中抑郁症状和障碍的1个月点患病率为10%，如下：重度抑郁障碍（MDD）2.3%，心境恶劣障碍（DD）2.3%，抑郁障碍（DD）2.3%。1.5%轻度抑郁障碍（MinD）; 3.9%亚综合征抑郁症状（SSD，定义为两个或两个以上的抑郁症状低于MinD，DD或MDD的诊断阈值）。在这个社区样本中似乎有两类SSD：第一，SSD，它是作为单极重性抑郁症（MDD）过程中不可或缺的组成部分发生的;第二，SSD自发发生在非单极抑郁社区受试者中。在第一种情况下，SSD通常是MinD或MDD发作的前驱症状，或者是消退发作的残留症状。分析还支持SSD是一种具有临床意义的单相MDD的间期抑郁亚型的结论，因为SSD在6项不良结局指标中的5项与有害功能障碍相关，既往重度抑郁发作史的患病率显著增加，自杀企图的终生患病率升高。在波1的亚综合征抑郁症或抑郁障碍诊断与1年后在波2访谈中获得的诊断的比较，证实了在这个大的代表性社区受访者样本中抑郁症的持续性和慢性性质，其中71%的受试者在波1有抑郁症状或障碍，在波2继续有症状。此外，受试者在第一波和第二波之间的第一年观察窗口期间经历了令人惊讶的抑郁症状和障碍诊断的变化程度，其中一个显着百分比的个体，他们在一年开始时处于抑郁症状或障碍诊断类别，在另一年结束时。这使我们假设，单极MDD的典型临床表现是动态的和多形性的，其特征是大量的症状流动性，其中患者在病程中经常从一种抑郁亚型改变诊断为另一种。(C)1997年Elsevier Science B.V.
Analyses conducted in 10 526 community respondents investigated by the NIMH Epidemiological Catchment Area (EGA) Program, revealed the 1-month point prevalence of depressive symptoms and disorders in the general population, at the first ECA interview (Wave 1) to be 10%, as follows: 2.3% major depressive disorder (MDD); 2.3% dysthymic disorder (DD); 1.5% minor depressive disorder (MinD); and 3.9% subsyndromal depressive symptoms (SSD, defined as two or more depressive symptoms beneath the diagnostic threshold of MinD, DD or MDD). There appears to be two classes of SSD in this community sample: first, SSD, which occurred as an integral component of the course of unipolar major depressive disorder (MDD); and, second, SSD occurring spontaneously in non-unipolar depressed community subjects. In the first instance, SSD was frequently prodromal to episodes of MinD or MDD or residual to resolving episodes. Analyses also support the conclusion that SSD is a clinically significant, interepisode, depressive subtype of unipolar MDD, since SSD is associated with harmful dysfunction in five of six measures of adverse outcome, has a significantly increased prevalence of past histories of major depressive episodes, and an elevated lifetime prevalence of suicide attempts. Comparison of subsyndromal depressive symptomatology or depressive disorder diagnoses at Wave 1 with diagnoses obtained, 1 year later, at the Wave 2 interview, confirm the persistent and chronic nature of depression in this large representative sample of community respondents, in which 71% of subjects with depressive symptoms or disorders at Wave 1 continued to be symptomatic at Wave 2. In addition, subjects experienced a surprising degree of change in depressive symptom and disorder diagnoses during the I-year observational window between Wave 1 and Wave 2, in which a remarkable percentage of individuals, who began the year in a depressive symptom or disorder diagnostic category, ended the year in another. This has led us to hypothesize that the typical clinical picture of unipolar MDD is dynamic and pleomorphic in nature, characterized by substantial symptomatic fluidity, in which patients frequently change diagnoses from one depressive subtype to another during their course of illness. (C) 1997 Elsevier Science B.V.