Boundaries of major depression: an evaluation of DSM-IV criteria.
Boundaries of major depression: an evaluation of DSM-IV criteria.
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DOI：
10.1176/ajp.155.2.172
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发表时间：
1998-02
期刊：
影响因子：
--
通讯作者：
K. Kendler;C. Gardner
中科院分区：
文献类型：
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作者：
K. Kendler;C. Gardner
目的：目前对重性抑郁症和轻度亚综合征抑郁状态之间的界限知之甚少。关于抑郁症状，DSM-IV是否“在关节处雕刻自然”？方法在一个基于人口的登记处，作者亲自采访了一对女性双胞胎，检查了在过去一年中评估的抑郁综合征的沿着三个维度的一系列值是否（DSM-III-R中列出的严重抑郁发作诊断标准A下的症状数量，对症状进行评分所需的严重程度或损害水平，和发作持续时间）预测指数双胞胎未来抑郁发作和双胞胎中重度抑郁症的风险。结果：标准A症状数量的增加，以单调的方式预测，指数双胞胎未来抑郁发作的风险更大，以及双胞胎中重度抑郁症的风险更大。没有这种一致的关系被视为与事件的持续时间。对于严重程度，一个单一的单调函数预测的风险，在双胞胎，而指数双胞胎与严重损害有一个显着更高的风险，为未来的发作比那些不太严重的损害。四个或更少的标准A症状，症状组成的综合征，涉及没有或最小的损害，和发作不到14天的持续时间都显着预测未来抑郁发作的指数双胞胎和风险的重大抑郁症的共同双胞胎。结论：作者发现很少有经验支持DSM-IV要求2周的持续时间，5种症状或临床显著损害。大多数功能似乎是连续的。这些结果表明，重性抑郁症-如DSM-IV所述-可能是一种诊断惯例，适用于不同严重程度和持续时间的连续抑郁症状。
OBJECTIVE Little is known about the boundaries between major depression and milder subsyndromal depressive states. With respect to depressive symptoms, does DSM-IV "carve nature at its joints"? METHOD In personally interviewed female twins from a population-based registry, the authors examined whether a range of values along three dimensions of the depressive syndrome assessed in the last year (number of symptoms listed in DSM-III-R under diagnostic criterion A for major depressive episode, level of severity or impairment required to score symptoms as present, and duration of episode) predicted future depressive episodes in the index twin and risk of major depression in the co-twin. RESULTS An increasing number of criterion A symptoms predicted, in a monotonic fashion, a greater risk for future depressive episodes in the index twin as well as a greater risk for major depression in the co-twin. No such consistent relationship was seen with duration of episode. For severity, a single monotonic function predicted risk in the co-twin, while index twins with severe impairment had a substantially higher risk for future episodes than did those with less severe impairment. Four or fewer criterion A symptoms, syndromes composed of symptoms involving no or minimal impairment, and episodes of less than 14 days' duration all significantly predicted both future depressive episodes in the index twin and risk of major depression in the co-twin. CONCLUSIONS The authors found little empirical support for the DSM-IV requirements for 2 weeks' duration, five symptoms, or clinically significant impairment. Most functions appeared continuous. These results suggest that major depression--as articulated by DSM-IV--may be a diagnostic convention imposed on a continuum of depressive symptoms of varying severity and duration.