Stressful life events and previous episodes in the etiology of major depression in women: An evaluation of the "kindling" hypothesis
Stressful life events and previous episodes in the etiology of major depression in women: An evaluation of the "kindling" hypothesis
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DOI：
10.1176/appi.ajp.157.8.1243
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发表时间：
2000-08-01
影响因子：
17.7
通讯作者：
Gardner, CO
中科院分区：
文献类型：
--
作者：
Kendler, KS;Thornton, LM;Gardner, CO
目的：尽管先前的证据表明，与首次发病病例相比，生活压力事件在复发性抑郁症中的病因学作用更小，但由于先前研究的方法学局限性，这个问题值得重新审视。方法：从基于人口的登记处（N = 2395）中选取女性-女性双胞胎，在9年的时间里对其进行了4次访谈，形成了一个包含97515人月和1380例重度抑郁症发病的研究小组。使用离散时间生存、比例风险模型和分段回归分析来检验生活事件暴露与既往抑郁发作次数在预测重度抑郁症发作中的相互作用。结果：对于0 - 9次抑郁发作的患者，压力生活事件的抑郁诱发作用随着发作次数的增加而显著下降。然而，压力生活事件与重度抑郁症之间的联系并没有受到额外发作的实质性影响。这种结果模式对于事件严重程度指数、遗传风险测量和独立压力生活事件限制的增加是稳健的。同样的模式也被发现在检查个人发作次数的变化。结论：以往抑郁发作次数与应激性生活事件对重度抑郁症的致病影响之间可能存在因果关系和双相关系。通过大约9次发作，压力生活事件暴露与重度抑郁症风险之间的关联逐渐下降，但在进一步发作时基本保持不变。这些结果与点火假说一致，但暗示了一个阈值，在这个阈值上，心智/大脑不再对抑郁状态额外敏感。
Objective: Although previous evidence has suggested that the etiologic role of stressful life events in major depression is reduced in recurrent versus first-onset cases, this question deserves reexamination because of potential methodological limitations of the previous studies.Method: Members of female-female twin pairs from a population-based registry (N = 2,395), who were interviewed four times over a period of 9 years, formed a study group that contained 97,515 person-months and 1,380 onsets of major depression. Discrete-time survival, proportional hazards model, and piece-wise regression analyses were used to examine the interaction between life event exposure and number of previous depressive episodes in the prediction of episodes of major depression.Results: For those with zero to nine previous depressive episodes, the depressogenic effect of stressful life events declined substantially with increasing episode number. However, the association between stressful life events and major depression was not substantially influenced by additional episodes. This pattern of results was robust to the addition of indices of event severity, measures of genetic risk, and restriction to independent stressful life events. The same pattern was also seen upon examining within-person changes in number of episodes.Conclusions: The association between previous number of depressive episodes and the pathogenic impact of stressful life events on major depression is likely causal and biphasic. Through approximately nine episodes, the association between stressful life event exposure and risk of major depression progressively declines but is largely unchanged with further episodes. These results are consistent with the kindling hypothesis but suggest a threshold at which the mind/brain is no longer additionally sensitized to the depressive state.