Lost human capital from early-onset chronic depression
Lost human capital from early-onset chronic depression
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DOI：
10.1176/appi.ajp.157.6.940
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发表时间：
2000-06-01
影响因子：
17.7
通讯作者：
Keller, MB
中科院分区：
文献类型：
--
作者：
Berndt, ER;Koran, LM;Keller, MB
目的：对于许多人来说，慢性抑郁症在很小的时候就开始了，可能会影响他们“人力资本”的积累(即教育，更多的教育可以扩大职业选择和增加收入潜力)。作者按性别研究了早发性(22岁之前)与晚发性抑郁症对教育程度的影响。他们还确定了抗抑郁药物治疗的有效性和可持续性以及心理社会结果是否因发病年龄而异，并量化了早发与晚发以及从不发生的影响。方法：作者使用Logistic和多元回归方法分析了一项三阶段、多中心、双盲、随机试验的数据，该试验比较了舍曲林和丙咪嗪对531名30岁及以上慢性抑郁症患者的治疗效果。这些数据与美国人口普查局1995年按年龄、教育程度和性别划分的收入数据相结合。结果：早发性抑郁症对女性的教育程度产生了不利影响，但对男性的教育程度没有影响。在急性治疗12周或维持治疗76周后，没有观察到发病年龄的治疗反应性有显著差异。1995年随机抽取的21岁早发性抑郁症女性，其未来年收入可能比21岁以后发病或根本没有发病的21岁女性低12%~18%。结论：早发性抑郁症会造成大量人力资本损失，尤其是对女性而言。发现并有效治疗早发性重度抑郁障碍可能会带来可观的经济效益。
Objective: Chronic depression starts at an early age for many individuals and could affect their accumulation of "human capital" (i.e., education, higher amounts of which can broaden occupational choice and increase earnings potential). The authors examined the impact, by gender, of early- (before age 22) versus late-onset major depressive disorder on educational attainment. They also determined whether the efficacy and sustainability of antidepressant treatments and psychosocial outcomes vary by age at onset and quantified the impact of early-versus late-onset, as well as never-occurring. major depressive disorder on expected lifetime earnings.Method: The authors used logistic and multivariate regression methods to analyze data from a three-phase, multicenter, double-blind, randomized trial that compared sertraline and imipramine treatment of 531 patients with chronic depression aged 30 years and older. These data were integrated with U.S. Census Bureau data on 1995 earnings by age, educational attainment, and gender.Results: Early-onset major depressive disorder adversely affected the educational attainment of women but not of men. No significant difference in treatment responsiveness by age at onset was observed after 12 weeks of acute treatment or, for subjects rated as having responded, after 76 weeks of maintenance treatment. A randomly selected 21-year-old woman with early-onset major depressive disorder in 1995 could expect future annual earnings that were 12%-18% lower than those of a randomly selected 21-year-old woman whose onset of major depressive disorder occurred after age 21 or not at all.Conclusions: Early-onset major depressive disorder causes substantial human capital loss, particularly for women. Detection and effective treatment of early-onset major depressive disorder may have substantial economic benefits.