PROSPECTIVE STUDY OF SUBSTANCE-INDUCED AND INDEPENDENT MAJOR DEPRESSIVE DISORDER AMONG INDIVIDUALS WITH SUBSTANCE USE DISORDERS IN A NATIONALLY REPRESENTATIVE SAMPLE
PROSPECTIVE STUDY OF SUBSTANCE-INDUCED AND INDEPENDENT MAJOR DEPRESSIVE DISORDER AMONG INDIVIDUALS WITH SUBSTANCE USE DISORDERS IN A NATIONALLY REPRESENTATIVE SAMPLE
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DOI：
10.1002/da.22122
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发表时间：
2013-06-01
影响因子：
7.4
通讯作者：
Blanco, Carlos
中科院分区：
文献类型：
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作者：
Magidson, Jessica F.;Wang, Shuai;Blanco, Carlos
抑郁症和物质使用障碍（substance use disorders，SUDs）常同时发生，这对独立的重性抑郁障碍（major depression disorder，MDD）和物质诱导的抑郁障碍（substance induced depression disorder，SIDD）的分类提出了挑战。目前尚不清楚，是否有不同的特点和/或模式的时间进程区分MDD-SUD和SIDD，以指导这些决定。此外，有证据表明，相当一部分患有SIDD的个体后来被重新分类为患有独立的MDD。持续的研究，以提高我们对这两者之间的差异和随着时间的推移在重新分类的变化的理解是必要的诊断澄清，并指导临床决策时，治疗抑郁症的背景下，SUD。方法目前的研究比较了基线时MDD-SUD与SIDD患者，并在一个大型的全国代表性流行病学样本（n = 2，121）中检查了3年随访期间DSM-IV轴I诊断的重新分类。结果发现SIDD在两个时间点都非常罕见。在基线时，与独立MDD患者相比，SIDD患者更可能是非白人，受教育程度较低，不太可能有保险，不太可能有心境恶劣或酒精滥用，更可能有药物依赖。在第1波SIDD患者中，在第1波和第2波之间有抑郁发作，绝大多数（>95%）有独立的MDD，而不是SIDD。在第2波时，其他心境障碍或SUD的发生率无显著组间差异。结论本研究结果对SUD背景下抑郁症的分类和治疗具有重要的病因学和治疗意义。(C)2013 Wiley Periodicals，Inc.
Background Depression and substance use disorders (SUDs) commonly co-occur, which presents diagnostic challenges in classifying independent major depressive disorder (MDD) versus substance-induced depressive disorder (SIDD). It remains unclear if distinct characteristics and/or patterns in temporal course distinguish MDD-SUD and SIDD to guide these decisions. Further, evidence suggests that a significant portion of individuals with SIDD are later reclassified as having independent MDD. Continued research to improve our understanding of differences between these two and changes in reclassification over time is necessary for diagnostic clarification and to guide clinical decisions when treating depression in the context of SUDs. Methods The current study compared individuals with MDD-SUD versus SIDD at baseline and examined reclassification of DSM-IV Axis I diagnoses over a 3-year follow up in a large, nationally representative epidemiological sample (n = 2,121). Results Findings demonstrated that SIDD was extremely rare at both time points. At baseline, individuals with SIDD were more likely to be non-White, have less education, less likely to have insurance, less likely to have dysthymia or alcohol abuse, and more likely to have drug dependence compared to those with independent MDD. Of individuals with SIDD at Wave 1 who had a depressive episode between Waves 1 and 2, the overwhelming majority (>95%) had an independent MDD, not SIDD, episode. There were no significant group differences in the incidence of other mood disorders or SUDs at Wave 2. Conclusions Findings have important etiological and treatment implications for the classification and treatment of depression in the context of SUDs. (C) 2013 Wiley Periodicals, Inc.