Childhood parental loss and risk for first-onset of major depression and alcohol dependence: the time-decay of risk and sex differences
Childhood parental loss and risk for first-onset of major depression and alcohol dependence: the time-decay of risk and sex differences
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DOI：
10.1017/s0033291702006219
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发表时间：
2002-10-01
影响因子：
6.9
通讯作者：
Prescott, CA
中科院分区：
文献类型：
--
作者：
Kendler, KS;Sheth, K;Prescott, CA
背景虽然一些研究表明，父母的损失与抑郁症（MD）的风险增加有关，但对可能的性别差异，诊断特异性和损失影响的时间过程知之甚少。首次发病的MD和酒精依赖（AD）进行了评估，在个人访谈5070双胞胎从同性（SS）和2118从异性（OS）双胞胎对确定从人口为基础的登记。考克斯比例风险（PH）和非比例风险（NPH）模型，检查首次发病的MD和AD，与双胞胎的SS对和条件logistic回归OS对。17岁以前的亲子分离分为死亡和其他原因分离。对于MD而不是AD，拒绝了风险恒定增加的PH假设，因为损失对风险的影响。NPH模型发现死亡和分离后MD的风险显着增加，分离的风险持续时间更长。对于AD，PH模型发现父母分居后风险显著增加，但死亡没有。在SS和OS双胞胎中，父母离异对MD风险的影响没有性别差异，而分离与AD风险之间的相关性在女性中显著强于男性。一致的性别差异与父母的损失被视为AD，但没有MD。对丧失后风险增加的时间过程的分析表明，可能反映不同关系的三种不同模式：父母死亡和MD（在类似于12年内恢复到基线），分离和MD（在类似于30年内恢复到基线）以及分离和AD（风险随时间无变化）。
Background. Whereas a number of studies have suggested that parental loss is associated with increased risk for major depression (MD), much less is known about possible gender differences, diagnostic specificity and the time course of the impact of loss.Method. First-onsets for MD and alcohol dependence (AD) were assessed at personal interviews in 5070 twins from same-sex (SS) and 2118 from opposite-sex (OS) twin pairs ascertained from a population-based registry. Cox Proportional Hazard (PH) and Non-Proportional Hazard (NPH) models, examining first onsets of MD and AD, were used with twins from SS pairs and conditional logistic regression for OS pairs. Parent-child separations prior to age 17 were divided into death and separation from other causes.Results. The PH assumptions of constant increased risk were rejected for the impact of loss on risk for MD but not for AD. NPH models found significantly increased risk for MD after both death and separation with the risk lasting much longer for separations. For AD, the PH model found significantly increased risk after parental separation but not death. In both SS and OS twin pairs, no sex differences were seen in the impact of parental loss on risk for MD whereas the association between separation and risk for AD was significantly stronger in females than in males.Conclusion. Consistent sex differences in the association with parental loss were seen for AD but not MD. The analysis of the time-course of increased risk after loss suggests three different patterns which may reflect different relationships: parental death and MD (return to baseline within similar to 12 years), separation and MD (return to baseline within similar to 30 years) and separation and AD (no change in risk over time).