Predictors of diagnostic conversion from major depression to bipolar disorder: a Swedish national longitudinal study.
Predictors of diagnostic conversion from major depression to bipolar disorder: a Swedish national longitudinal study.
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DOI：
10.1017/s0033291723001848
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发表时间：
2023-12
影响因子：
6.9
通讯作者：
Kendler, Kenneth S.
中科院分区：
文献类型：
--
作者：
Rhee, Sang Jin;Ohlsson, Henrik;Sundquist, Jan;Sundquist, Kristina;Kendler, Kenneth S.
预测重度抑郁症（MD）向双相情感障碍（BD）的转变具有重要的临床意义。因此，我们试图确定相关的转化率和风险因素。这项队列研究包括了1941年以后出生的瑞典人口。数据收集自瑞典人口登记册。潜在的危险因素，包括家庭遗传风险评分（FGRS），这是基于大家庭中亲属的表型而不是分子数据计算的，以及这些登记册中的人口学/临床特征。2006年首次注册医学博士的患者随访至2018年。采用Cox比例风险模型对BD转换率及相关危险因素进行分析。对晚期转化者进行了额外的分析，并按性别分层。13年的累计转换发生率为5.84%[95%可信区间（95% CI） 5.72-5.96]。在多变量分析中，转换的最强危险因素是BD的高FGRS[危险比(HR) = 2.73, 95% CI 2.43-3.08]、住院治疗环境（HR = 2.64, 95% CI 2.44-2.84）和精神病性抑郁（HR = 2.58, 95% CI 2.14-3.11）。对于晚期转化者，与基线模型相比，在青少年时期首次登记MD是一个更强的风险因素。当风险因素和性别之间的相互作用显著时，性别分层显示，它们在女性中更具预测性。双相障碍家族史、住院治疗和精神病症状是MD转化为双相障碍的最强预测因子。
It is clinically important to predict the conversion of major depression (MD) to bipolar disorder (BD). Therefore, we sought to identify related conversion rates and risk factors. This cohort study included the Swedish population born from 1941 onward. Data were collected from Swedish population-based registers. Potential risk factors, including family genetic risk scores (FGRS), which were calculated based on the phenotypes of relatives in the extended family and not molecular data, and demographic/clinical characteristics from these registers were retrieved. Those with first MD registrations from 2006 were followed up until 2018. The conversion rate to BD and related risk factors were analyzed using Cox proportional hazards models. Additional analyses were performed for late converters and with stratification by sex. The cumulative incidence of conversion was 5.84% [95% confidence interval (95% CI) 5.72–5.96] for 13 years. In the multivariable analysis, the strongest risk factors for conversion were high FGRS of BD [hazard ratio (HR) = 2.73, 95% CI 2.43–3.08], inpatient treatment settings (HR = 2.64, 95% CI 2.44–2.84), and psychotic depression (HR = 2.58, 95% CI 2.14–3.11). For late converters, the first registration of MD during the teenage years was a stronger risk factor when compared with the baseline model. When the interactions between risk factors and sex were significant, stratification by sex revealed that they were more predictive in females. Family history of BD, inpatient treatment, and psychotic symptoms were the strongest predictors of conversion from MD to BD.
影响因子：
4.7
作者：
Xu, Zhi;Chen, Lei;Hu, Yunyun;Shen, Tian;Chen, Zimu;Tan, Tingting;Gao, Chenjie;Chen, Suzhen;Chen, Wenji;Chen, Bingwei;Yuan, Yonggui;Zhang, Zhijun
通讯作者：
Zhang, Zhijun