Understanding the heterogeneity of depression through the triad of symptoms, course and risk factors: a longitudinal, population-based study
Understanding the heterogeneity of depression through the triad of symptoms, course and risk factors: a longitudinal, population-based study
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DOI：
10.1016/s0165-0327(99)00132-9
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发表时间：
2000-07-01
影响因子：
6.6
通讯作者：
Nestadt, G
中科院分区：
文献类型：
--
作者：
Chen, LS;Eaton, WW;Nestadt, G
背景：目前正在进行一项研究，以检验抑郁症是否是一种同质的临床综合征，并根据抑郁症状的数量和性质确定有效和有用的亚型。本研究总结了一般人群前瞻性研究中明显的抑郁症状模式，并通过研究其病程和病因异质性来检验潜在亚型的有效性。方法：从巴尔的摩流行病学集水区(ECA)随访研究(1981-1993/6)中抽取1920名成年人(年龄18-96岁)作为一般人群样本。使用诊断性面谈计划(DIS)收集有关诊断、症状、病程和危险因素的数据。采用潜类分析方法总结症状类型。根据症状组或症状模式的数量，比较不同潜在亚型的病程特征和危险因素分布。采用Logistic回归模型分析各亚型之间的病原学异质性。结果：症状组的数量对不同的病因过程提供了最有效的了解，重度抑郁症(7-9个症状组)与女性性别、抑郁症家族史有关，但与第一次发病前的应激性生活事件无关。中度(5~6个症状组)和轻度抑郁(3~4个症状组)与抑郁症家族史、发病前应激性生活事件有关，与女性无关。潜伏班模型产生的抑郁精神病理模式如下：快感缺乏、自杀、精神运动和严重抑郁亚型。厌食症亚型表现出不同于其他亚型的病程和危险因素。局限性：精神病理学的测量是基于自我报告的DIS访谈，而不是精神病学评估。在确定家族史和应激性生活事件时，不能排除回忆或报告偏见。结论：抑郁症是异质性的，甚至低于症状诊断的门槛。发作的严重程度似乎比症状的模式更能提供信息，可能的例外情况是假定的非享乐性亚型。(C)2000 Elsevier Science B.V.保留所有权利。
Background: There is an ongoing research effort to test if depression is a homogeneous clinical syndrome and to identify valid and useful subtypes based on the number and nature of depressive symptoms. This study summarizes the patterns of depressive symptoms evident in a prospective study of the general population and examines the validity of potential subtypes by studying their course and etiologic heterogeneity, Methods: A general population sample of 1920 adults (aged 18-96) from the Baltimore Epidemiologic Catchment Area (ECA) follow-up study (1981 to 1993/6) were examined. Data on diagnoses, symptoms, course and risk factors were collected using the Diagnostic Interview Schedule (DIS). Latent class analysis was applied to summarize symptom patterns. Course characteristics and risk factor profiles were compared among potential subtypes based on the number of symptom groups or symptom patterns. Logistic regression models were used to examine the etiologic heterogeneity among potential subtypes based on symptoms. Results: The number of symptom groups gave the most efficient insight into differential etiologic processes, Severe depression (7-9 symptom groups) was associated with female gender, family history of depression but not with stressful life events before the onset of the first episode. Moderate (5-6 symptom groups) and mild depression (3-4 symptom groups) were associated with family history of depression, stressful life events before the onset, but not with female gender. The latent class model generated patterns of depressive psychopathology as follows: anhedonia, suicidal, psychomotor, and severely depressed subtypes. The Anhedonia subtype showed a course and risk factor profile distinct from the others. Limitations: The measurement of psychopathology was based on self-reported DIS interviews instead of psychiatric assessments. Recall or report bias cannot be excluded in the ascertainment of family history and stressful life events. Conclusions: Depression is heterogeneous, even below the threshold of syndromal diagnosis. The severity of an episode appears to be more informative than the pattern of symptoms, with the possible exception of a putative anhedonic subtype. (C) 2000 Elsevier Science B.V. All rights reserved.