Offspring of Depressed Parents: 30 Years Later
Offspring of Depressed Parents: 30 Years Later
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DOI：
10.1176/appi.ajp.2016.15101327
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发表时间：
2016-10-01
影响因子：
17.7
通讯作者：
Talati, Ardesheer
中科院分区：
文献类型：
--
作者：
Weissman, Myrna M.;Wickramaratne, Priya;Talati, Ardesheer
目的：虽然抑郁父母的生物学后代中精神病理学风险增加已被广泛复制，但其整个风险年龄的长期结果却鲜为人知。作者提出了一个30年的后续行动的生物后代（平均年龄=47岁）的抑郁症（高风险）和非抑郁症（低风险）parents.Method：一百四十七个后代的中度至重度抑郁症或非抑郁症的父母从同一社区选择了长达30年。诊断评估是在不了解父母临床状况的情况下进行的。最终诊断由设盲的医学博士进行。或博士结果：高风险后代患抑郁症的风险大约是高风险后代的三倍。在两组中，首次发病的最高风险时期是15至25岁。青春期前发病是罕见的，但高风险的后代有超过10倍的风险增加。抑郁症父母的后代中早期出现的重度抑郁症并没有被低风险组在他们成熟时较晚的首次发病所抵消。高危组中抑郁症发病率的增加主要是由于早期发病，但高危组中晚期复发率显著增加。高风险的后代继续有整体较差的功能，并接受更多的治疗情绪问题。由于非自然原因，高风险组的死亡率增加（5.5%与2.5%），平均死亡年龄相差近8年（38.8岁与46.5岁）。结论：抑郁症父母的后代仍然处于抑郁症、发病率和死亡率的高风险中，并持续到中年。虽然青春期是这两个风险群体中重性抑郁症的主要发病期，但随着年龄的增长，有家族史的后代会继续复发和预后不良。在个性化医疗时代，直到发现对个体风险的更生物学基础的理解，作为临床护理的一部分，对重度抑郁症的简单家族史评估可以预测长期风险的个体。
Objective: While the increased risk of psychopathology in the biological offspring of depressed parents has been widely replicated, the long-term outcome through their full age of risk is less known. The authors present a 30-year follow-up of biological offspring (mean age=47 years) of depressed (high risk) and nondepressed (low-risk) parents.Method: One hundred forty-seven offspring of moderately to severely depressed or nondepressed parents selected from the same community were followed for up to 30 years. Diagnostic assessments were conducted blind to parents' clinical status. Final diagnoses were made by a blinded M.D. or Ph.D. evaluator.Results: The risk for major depression was approximately three times as high in the high-risk offspring. The period of highest risk for first onset was between ages 15 and 25 in both groups. Prepubertal onsets were uncommon, but high-risk offspring had over 10-fold increased risk. The early onset of major depression seen in the offspring of depressed parents was not offset by later first onsets in the low-risk group as they matured. The increased rates of major depression in the high-risk group were largely accounted for by the early onsets, but later recurrences in the high risk group were significantly increased. The high-risk offspring continue to have overall poorer functioning and receive more treatment for emotional problems. There was increased mortality in the high-risk group (5.5% compared with 2.5%) due to unnatural causes, with a nearly 8-year difference in the mean age at death (38.8 years compared with 46.5 years).Conclusions: The offspring of depressed parents remain at high risk for depression, morbidity, and mortality that persists into their middle years. While adolescence is the major period of onset for major depression in both risk groups, it is the offspring with family history who go on to have recurrences and a poor outcome as they mature. In the era of personalized medicine, until a more biologically based understanding of individual risk is found, a simple family history assessment of major depression as part of clinical care can be a predictor of individuals at long-term risk.