Toward a comprehensive developmental model for major depression in women
Toward a comprehensive developmental model for major depression in women
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DOI：
10.1176/appi.ajp.159.7.1133
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发表时间：
2002-07-01
影响因子：
17.7
通讯作者：
Prescott, CA
中科院分区：
文献类型：
--
作者：
Kendler, KS;Gardner, CO;Prescott, CA
抑郁症是一种多因素的疾病，有许多病因学变量，通过发展途径相互关联。作者使用结构方程模型来产生一个发展模型的病因学的重性抑郁症women.METHODData从1,942成年女性双胞胎，采访了4次，超过9年的时间，被用来构建一个发展模型来预测抑郁发作前一年的最近一次采访。考虑了五个发育等级中的18个风险因素：1）童年（遗传风险、家庭环境紊乱、儿童期性虐待和儿童期失去父母），2）青春期早期（神经质、自尊、早发性焦虑和品行障碍），3）青春期后期（教育程度、终生创伤、社会支持和药物滥用），4）成年（离婚史和既往抑郁症史），以及5）最近一年（婚姻问题、困难和压力性生活事件）。最佳拟合模型包括6个相关性和64条路径，为数据提供了极好的拟合，并解释了52%的重性抑郁症发作倾向的变异。研究结果表明，发展中国家的风险为女性抑郁症的结果从三个广泛的途径，反映内化症状，外化症状，和psychosocial advertisement.CONCLUSIONSMajor抑郁症是一种病因复杂的疾病，充分了解这将需要考虑广泛的风险因素，从多个领域。这些结果虽然可信，但应谨慎对待，因为存在因果推断、回顾性回忆偏倚和纯相加统计模型的局限性等问题。
OBJECTIVEMajor depression is a multifactorial disorder with many etiologic variables that are interrelated through developmental pathways. The authors used structural equation modeling to generate a developmental model for the etiology of major depression in women.METHODData from 1,942 adult female twins, interviewed up to four times over a 9-year period, were used to construct a developmental model to predict depressive episodes in the year before the most recent interview. Eighteen risk factors in five developmental tiers were considered: 1) childhood (genetic risk, disturbed family environment, childhood sexual abuse, and childhood parental loss), 2) early adolescence (neuroticism, self-esteem, and early-onset anxiety and conduct disorder), 3) late adolescence (educational attainment, lifetime traumas, social support, and substance misuse), 4) adulthood (history of divorce and past history of major depression), and 5) the last year (marital problems, difficulties, and stressful life events).RESULTSThe best fitting model included six correlations and 64 paths, provided an excellent fit to the data, and explained 52% of the variance in liability to episodes of major depression. The findings suggest that the development of risk for major depression in women results from three broad pathways reflecting internalizing symptoms, externalizing symptoms, and psychosocial adversity.CONCLUSIONSMajor depression is an etiologically complex disorder, the full understanding of which will require consideration of a broad array of risk factors from multiple domains. These results, while plausible, should be treated with caution because of problems with causal inference, retrospective recall bias, and the limitations of a purely additive statistical model.