Postpartum depression: the distribution of severity in a community sample.
Postpartum depression: the distribution of severity in a community sample.
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产后抑郁症：社区样本中的严重程度分布。
DOI：
10.1007/s00737-011-0228-0
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发表时间：
2011
期刊：
影响因子：
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通讯作者：
Stuart,Scott
中科院分区：
文献类型：
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作者：
Pollack,LaurenO;Segre,LisaS;O'Hara,MichaelW;Stuart,Scott
尊敬的编辑， 大量流行病学研究已明确证实产后抑郁症 (PPD) 的患病率（Gavin 等人，2005 年）。然而，由于 PPD 状态通常是二分的，并且基于重度抑郁症 (MDD) 的 DSM-IV 标准或既定的截止分数，因此对于诊断为抑郁症的患者中症状严重程度的变化知之甚少。考虑抑郁女性严重程度的差异不仅可以为治疗转诊提供信息，而且还可以提高识别治疗试验的研究参与者的特异性，并且可以更准确地解释不同的治疗反应。为了描述临床抑郁症女性样本中抑郁症严重程度的变化，我们分析了先前收集的数据集（O'Hara 等人，2000 年），其中包括来自 292 名被招募参加治疗试验的女性的人口统计和诊断数据。该数据反映了治疗前的抑郁状态。从人口结构来看，这些女性主要是白人（96.9%，n=283）、非西班牙裔（97.9%，n=286）和已婚女性（87.7%，n=256），平均年龄为 28.4 岁。超过一半（59.9%，n = 175）的就业者平均家庭年收入约为 40,200 美元，平均受教育程度为 14.6 年。根据 DSM-IV 疾病结构化临床访谈 (SCID)，所有女性均被诊断患有 MDD；患有轻度抑郁症的女性不包括在数据集中。每位女性均可获得汉密尔顿抑郁量表（HRSD）的分数。使用先前根据 HRSD 评分建立的五个抑郁严重程度级别（Furukawa 等人，2007 年），我们计算了每个严重程度的抑郁女性的频率。这些严重程度级别被定义为“1级——正常/无病”(HRSD 0-3)、“2级——临界病态”(HRSD 4-7)、“3级——轻度病态”(HRSD 8-15)、“4级——中度病态”(HRSD 16-26)和“5级——重病”(HRSD 27-50)。结果表明，即使在临床抑郁症的女性样本中，抑郁症的严重程度也存在很大差异（表 1）。值得注意的是，5% 的女性根据 SCID 被诊断患有 MDD，但 HRSD 评分较低。造成这种差异的一种解释是 SCID 和 HRSD 评估的时间段略有不同； SCID 评估上个月最差的两周，而 HRSD 评估过去一周。这些结果具有重要的治疗和研究意义。从阶梯式护理模式的角度来看，症状较轻的抑郁女性可能需要强度较低的治疗，例如支持小组，而症状较严重的抑郁女性可能需要更积极的治疗，例如治疗或药物治疗。为患有不同严重程度的产后抑郁症的女性量身定制的治疗计划有可能在时间和成本方面都很有效。这些结果也可能为临床研究提供信息，其中
Dear Editor, The prevalence of postpartum depression (PPD) is well established by a wealth of epidemiological studies (Gavin et al. 2005). Nevertheless, because PPD status is often dichotomous and based on DSM-IV criteria for major depressive disorder (MDD) or on an established cutoff score, little is known about the variation in symptom severity among those diagnosed as depressed. Accounting for variation in severity levels among depressed women would not only inform treatment referrals, but would also improve specificity in the identification of research participants for treatment trials and may more accurately account for differential treatment responses. To describe variation in depression severity in a sample of clinically depressed women, we analyzed a previously collected data set (O'Hara et al. 2000) with demographic and diagnostic data from 292 women who were recruited for a treatment trial. The data reflect pretreatment depression status. Demographically, these women were predominantly white (96.9%, n= 283), non-Hispanic (97.9%, n=286), and married (87.7%, n= 256,) with an average age of 28.4 years. Over half (59.9%, n= 175) were employed with an average annual household income of approximately US $40,200 and average educational level of 14.6 years. All women were diagnosed with MDD according to the Structured Clinical Interview for DSM-IV Disorders (SCID); women with minor depression were not included in the data set. Scores on the Hamilton Rating Scale for Depression (HRSD) were available for each woman. Using five previously established levels of depression severity based on HRSD scores (Furukawa et al. 2007), we calculated the frequency of depressed women at each severity level. These severity levels have been defined as “level 1—normal/no illness”(HRSD 0–3),“level 2—borderline ill”(HRSD 4–7),“level 3—mildly ill”(HRSD 8–15),“level 4—moderately ill”(HRSD 16–26), and “level 5—severely ill”(HRSD 27–50). The results indicate that even within a clinically depressed sample of women, there is a wide range of depression severity (Table 1). Noteworthy are the 5% of women who were diagnosed with MDD based on the SCID, yet received low HRSD scores. One explanation for this discrepancy is that the SCID and HRSD assess slightly different time periods; the SCID assesses the worst 2 weeks in the last month while the HRSD assesses the past week. These results have important treatment and research implications. From a stepped care model perspective, depressed women with symptoms in the mild range may require less intensive treatment, such as a support group, while depressed women with more severe symptoms may require more aggressive treatment, like therapy or medication. Tailored treatment plans for women suffering from different severity levels of PPD have the potential to be efficient in terms of both time and cost. These results are also potentially informative for clinical research where