Self-disparagement as feature and forerunner of depression: findings from the Stirling County Study.
Self-disparagement as feature and forerunner of depression: findings from the Stirling County Study.
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自我贬低是抑郁症的特征和先兆：斯特灵县研究的结果。
DOI：
10.1053/comp.2002.29842
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发表时间：
2002
影响因子：
7.3
通讯作者：
Leighton,AlexanderH
中科院分区：
文献类型：
--
作者：
Murphy,JaneM;Nierenberg,AndrewA;Monson,RichardR;Laird,NanM;Sobol,ArthurM;Leighton,AlexanderH
睡眠障碍作为抑郁症的早期指标已经引起了相当大的关注。然而，三项流行病学调查显示，自我贬低等心理症状是更强的预测因素。这份报告检查了现代流行病学调查中通常评估的抑郁症状，并使用斯特林县研究的数据估计了这些信息的普适性，斯特林县研究是一项关于精神疾病的长期流行病学调查。诊断访谈计划(DIS)被用来收集有关抑郁症的信息，抑郁症被定义为重度抑郁发作(MDE)和/或恶劣心境障碍(DysD)。1992年，代表斯特林县的1,396名成年人的样本被用来评估不同类型抑郁症状的流行率，并调查症状与MDE/DysD终生诊断之间的关系。一组489名在20世纪90年代早期两次接受采访的随访对象被用来检查基线症状和随后的MDE/DysD发病率之间的关系。同时调查了症状组(如食欲或精神运动障碍)和个别症状(如体重增加或躁动)。大约三分之一的代表性样本经历了诊断所需的悲伤或失去快乐的症状，但许多人缺乏足够的其他症状来诊断为抑郁症。与个别症状相比，几个症状组与诊断的关系不同。在后者中，在有代表性的样本中，感觉没有价值和难以集中注意力的[ldq]表现出最强的诊断相关性。在两次采访的队列中，想死的症状和感觉没有价值的症状是对未来抑郁的最具预测性的。因此，这项研究支持了其他流行病学研究的证据，即心理症状在抑郁症的前驱阶段是重要的。睡眠障碍，特别是失眠，不能被忽视，因为它是抑郁症的突出表现，但它似乎没有其他一些症状那样具有高度的特异性。只关注症状组，如用于根据诊断标准计算症状，可能会模糊有关个别症状与诊断之间关系的有用信息。在一般人群中，个人不充分的感觉值得特别关注，因为它们与终生诊断密切相关，并预测随着时间的推移人们抑郁的发生率。
Sleep disturbance has attracted considerable attention as an early indicator of depression. However, three epidemiologic investigations have shown psychological symptoms, such as self-disparagement, to be stronger predictors. This report examines the depressive symptoms commonly assessed in modern epidemiologic surveys and estimates the generalizability of this information using data from the Stirling County Study, a long-term epidemiologic investigation of psychiatric disorders. The Diagnostic Interview Schedule (DIS) was used to gather information about depression, defined as major depressive episode (MDE) and/or dysthymic disorder (DysD). A sample of 1,396 adults representing Stirling County in 1992 served to assess the prevalence of the different types of depressive symptoms and to investigate the associations between symptoms and lifetime diagnoses of MDE/DysD. A cohort of 489 follow-up subjects who were interviewed twice in the early part of the 1990s was used to examine the associations between baseline symptoms and subsequent incidence of MDE/DysD. Both [ldquo ]symptom groups[rdquo ] (such as appetite or psychomotor disturbances) and [ldquo ]individual symptoms[rdquo ] (such as weight gain or restlessness) were investigated. About one third of the representative sample had experienced the diagnostically required symptoms of [ldquo ]sadness[rdquo ] or [ldquo ]loss of pleasure,[rdquo ] but many lacked sufficient other symptomatology to be diagnosed as depressed. Several of the symptom groups bore a different relationship to diagnosis than did the individual symptoms. Among the latter, [ldquo ]feeling worthless[rdquo ] and [ldquo ]having trouble concentrating[rdquo ] exhibited the strongest associations to diagnosis in the representative sample. The symptoms of [ldquo ]wanting to die[rdquo ] and [ldquo ]feeling worthless[rdquo ] were the most predictive of future depression in the twice-interviewed cohort. Thus, this study supports evidence from other epidemiologic studies that psychological symptoms are important in the prodromal phase of depression. Sleep disturbance, especially insomnia, cannot be ignored since it is a prominent manifestation of depression but it appears not to have as high specificity as some of the other symptoms. An exclusive focus on the symptom groups, as used to count symptoms according to diagnostic criteria, may obscure useful information about associations between individual symptoms and diagnosis. Feelings of personal inadequacy deserve particular attention in the population at large because they are strongly associated with lifetime diagnoses and forecast the incidence of depression when people are followed over time.
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