Population-based study of first onset and chronicity in major depressive disorder
Population-based study of first onset and chronicity in major depressive disorder
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DOI：
10.1001/archpsyc.65.5.513
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发表时间：
2008-05-01
影响因子：
--
通讯作者：
Zandi, Peter
中科院分区：
文献类型：
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作者：
Eaton, William W.;Shao, Huibo;Zandi, Peter
背景：没有缺乏流行和临床偏差的重性抑郁症的自然史研究。目的：估计首次发病的危险因素和首次发作后的慢性参数，包括持续时间、恢复和复发，并寻找每个参数的预测因子。设计：前瞻性人群队列研究，随访23年。环境：东巴尔的摩，马里兰州，城市环境。参与者：1981年3481名成年家庭居民的概率样本，其中92名在随访过程中首次出现重度抑郁症，1739名其他参与者随访至少13年。结果测量：诊断性访谈时间表和生命表访谈。结果：女性参与者表现出较高的发病风险，发作持续时间较长，且复发风险较高的趋势不显著。性行为与康复无关。平均发作时间为12周。在92名首次发作的患者中，约有15%的人即使在23年后也没有一年没有发作。大约50%的首次发作的参与者恢复了，并且没有再发作。课程的发展从最初到后来的阶段是相对稳定的。具有1个或2个短的血清素转运基因等位基因的个体初始发作的风险较高，但发作持续时间较短。很少有强有力的预测恢复或复发的因素。结论：重性抑郁障碍持续发作的占15%，复发的占35%。首次发作的患者中约有一半会康复，不会再发作。
Context: There are no studies of the natural history of major depressive disorder that lack prevalence and clinic biases.Objectives: To estimate risk factors for first lifetime onset and parameters of chronicity following the first episode, including duration, recovery, and recurrence, and to search for predictors of each parameter.Design: Prospective population-based cohort study with 23 years of follow-up.Setting: East Baltimore, Maryland, an urban setting.Participants: Probability sample of 3481 adult household residents in 1981, including 92 with first lifetime onset of major depressive disorder during the course of the follow-up, and 1739 other participants followed up for at least 13 years.Outcome Measures: Diagnostic Interview Schedule and Life Chart Interview.Results: Female participants showed higher risk of onset of disorder, longer duration of episodes, and a nonsignificant tendency for higher risk of recurrence. Sex was not related to recovery. The median episode length was 12 weeks. About 15% of 92 individuals with first episodes did not have a year free of episodes, even after 23 years. About 50% of first episode participants recovered and had no future episodes. The evolution of the course was relatively stable from first to later episodes. Individuals with 1 or 2 short alleles of the serotonin transporter gene were at higher risk for an initial episode, but experienced episodes of shorter duration. There were few strong predictors of recovery or recurrence.Conclusions: Major depressive disorder is unremitting in 15% of cases and recurrent in 35%. About half of those with a first-onset episode recover and have no further episodes.