Comparison of induced and independent major depressive disorders in 2,945 alcoholics.
Comparison of induced and independent major depressive disorders in 2,945 alcoholics.
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DOI：
10.1176/ajp.154.7.948
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发表时间：
1997-07
期刊：
影响因子：
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通讯作者：
M. Schuckit;J. Tipp;M. Bergman;W. Reich;V. Hesselbrock;Tom L. Smith
中科院分区：
文献类型：
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作者：
M. Schuckit;J. Tipp;M. Bergman;W. Reich;V. Hesselbrock;Tom L. Smith
目的：酒精依赖男性和女性的抑郁发作在病因和临床过程上是不同的。这项研究测试了关于两种潜在情感状态亚型的发病率和临床特征的三种假设：那些似乎是物质诱发的情绪障碍和那些独立的重度抑郁发作。方法：作为酒精中毒遗传学合作研究的一部分，对2945名酒精依赖者进行了半结构化的详细访谈。采用时间线法确定先证者、亲属和比较对象的情绪障碍类型，对有两种情绪障碍病史的个体进行比较。结果：15.2%的酗酒者在出现酒精依赖之前或随后的长时间戒断期间（即独立抑郁）出现重度抑郁发作，而26.4%的酗酒者报告至少有一次物质诱发的抑郁发作。根据逻辑回归分析，独立（与药物引起的）重度抑郁发作的受试者更有可能是已婚、白种人和女性，有较少的药物使用经验和较少的酒精中毒治疗，有自杀未遂的经历，并且根据与家庭成员的个人访谈，有一个患有重度情绪障碍的近亲。结论：这些结果支持这样一种观点，即有可能区分酒精成瘾者中物质诱发的抑郁发作和独立的抑郁发作。这种鉴别对于确定预后和最佳治疗可能很重要。
OBJECTIVE Depressive episodes among alcohol-dependent men and women are heterogeneous in causation and clinical course. This study tested three hypotheses regarding the rates and clinical characteristics of two potential subtypes of these affective states: those that appear to be substance-induced mood disorders and those that are independent major depressive episodes. METHOD Semistructured, detailed interviews were administered to 2,945 alcohol-dependent subjects as part of the Collaborative Study on the Genetics of Alcoholism. With the use of a time line method for determining the type of mood disorder among probands, relatives, and comparison subjects, individuals with histories of the two types of mood disorders were compared. RESULTS Major depressive episodes with an onset before the development of alcohol dependence or during a subsequent long abstinence period (i.e., independent depressions) were observed in 15.2% of the alcoholics, while 26.4% reported at least one substance-induced depressive episode. According to a logistic regression analysis, the subjects with independent (as compared to substance-induced) major depressive episodes were more likely to be married, Caucasian, and female, to have had experience with fewer drugs and less treatment for alcoholism, to have attempted suicide, and, on the basis of personal interviews with family members, to have a close relative with a major mood disorder. CONCLUSIONS These results support the contention that it is possible to differentiate between what appear to be substance-induced and independent depressive episodes in alcoholics. Such differentiation might be important for establishing prognosis and optimal treatment.