Incidence of social anxiety disorder and the consistent risk for secondary depression in the first three decades of life
Incidence of social anxiety disorder and the consistent risk for secondary depression in the first three decades of life
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DOI：
10.1001/archpsyc.64.8.903
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发表时间：
2007-08-01
影响因子：
--
通讯作者：
Wittchen, Hans-Ulrich
中科院分区：
文献类型：
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作者：
Beesdo, Katja;Bittner, Antje;Wittchen, Hans-Ulrich
背景：流行病学研究结果表明社交焦虑障碍（SAD）患者患抑郁症的风险增加，但儿童期和青少年早期的前瞻性纵向研究结果存在差异，对这一结论提出了挑战。
目的：研究社交焦虑障碍的发病模式、社交焦虑障碍与后续抑郁症关联的一致性，以及后续抑郁症的远端和近端预测因素。
设计：多达4次的面对面、为期10年的前瞻性纵向和家庭研究。由经过临床培训的访谈员进行《精神障碍诊断与统计手册》第四版慕尼黑复合性国际诊断访谈。
在该年龄范围内，抑郁症发病率不同，其特点是延迟且持续高发。社交焦虑障碍始终与后续抑郁症相关，与社交焦虑障碍的发病年龄无关（相对风险范围为1.49 - 1.85，控制年龄和性别）。粗略的考克斯回归显示，显著的远端（如父母焦虑或抑郁、行为抑制）和近端社交焦虑障碍特征（如严重程度指标、持续性）可作为预测因素。在多个模型中，大多数关联减弱，行为抑制（风险比为1.30[95%置信区间为1.04 - 1.62；P = 0.021]）以及不太一致的惊恐（风险比为1.85[95%置信区间为1.08 - 3.18；P = 0.031]）成为剩余的显著预测因素。
地点：慕尼黑的社区样本。
参与者：基线时年龄为14 - 24岁、随访时年龄为21 - 34岁的3021人。
主要结局指标：社交焦虑障碍和抑郁症（重度抑郁发作或心境恶劣）的累积发病率。
结果：社交焦虑障碍的累积发病率为11.0%；抑郁症为27.0%。社交焦虑障碍的标准化发病人年数在10 - 19岁人群中最高（0.72%），在此之前（0.20%）和之后（0.19%）较低。
结论：社交焦虑障碍是一种在青少年期发病的早期疾病，与后续患抑郁症的风险大幅且持续增加有关。证明抑郁症风险增加的近端尤其是远端预测因素需要进一步探索，以确定其调节或中介作用。结合先前的证据，即共病的社交焦虑障碍与抑郁症更恶性的病程和特征相关，这些结果呼吁有针对性的预防，以减轻社交焦虑障碍及其后果的负担。
Context: Epidemiological findings demonstrating an increased risk for individuals with social anxiety disorder (SAD) to develop depression have been challenged by discrepant findings from prospective longitudinal examinations in childhood and early adolescence.Objectives: To examine patterns of SAD incidence, the consistency of associations of SAD with subsequent depression, and distal and proximal predictors for subsequent depression.Design: Face-to-face, 10-year prospective longitudinal and family study of up to 4 waves. The DSM-IV Munich-Composite International Diagnostic Interview was administered by clinically trained interviewers. that age range. Depression incidence was different, characterized by delayed and continued high rates. Social anxiety disorder was consistently associated with subsequent depression, independent of age at onset for SAD (relative risk range, 1.49-1.85, controlling for age and sex). Crude Cox regressions showed significant distal (eg, parental anxiety or depression, behavioral inhibition) and proximal SAD characteristics (eg, severity measures, persistence) as predictors. Most associations were attenuated in multiple models, leaving behavioral inhibition (hazard ratio, 1.30 [95% confidence interval, 1.04-1.62; P=.021) and, less consistently, panic (hazard ratio, 1.85 [95% confidence interval, 1.08-3.18; P=.031) as the remaining significant predictors.Setting: Community sample in Munich.Participants: Three thousand twenty-one individuals aged 14 to 24 years at baseline and 21 to 34 years at follow-up.Main Outcome Measures: Cumulative incidence of SAD and depression (major depressive episode or dysthymia).Results: Cumulative incidence for SAD was 11.0%; for depression, 27.0%. Standardized person-years of incidence for SAD were highest for those aged 10 to 19 years (0.72%) and were low before (0.20%) and after (0.19%).Conclusions: Social anxiety disorder is an early, adolescent-onset disorder related to a substantially and consistently increased risk for subsequent depression. The demonstration of proximal and particularly distal predictors for increased depression risks requires further exploration to identify their moderator or mediator role. Along with previous evidence that comorbid SAD is associated with a more malignant course and character of depression, these results call for targeted prevention with the aim of reducing the burden of SAD and its consequences.