Causal relationship between stressful life events and the onset of major depression
Causal relationship between stressful life events and the onset of major depression
复制标题
DOI：
10.1176/ajp.156.6.837
复制
发表时间：
1999-06-01
影响因子：
17.7
通讯作者：
Prescott, CA
中科院分区：
文献类型：
--
作者：
Kendler, KS;Karkowski, LM;Prescott, CA
目的：应激性生活事件与重性抑郁症发作相关。然而，压力生活事件的暴露受到遗传因素的影响，这些因素与易患重度抑郁症的因素相关。这项研究的目的是澄清压力生活事件导致重度抑郁症的程度。方法：作者评估了15类压力生活事件的发生和DSM-III-R重度抑郁症的发作，这些女性双胞胎在1年的时间里从基于人群的登记中确定。样本包含24,648人月和316例重度抑郁症发作。压力生活事件被单独评定为上下文威胁和依赖性（压力生活事件可能由被调查者的行为导致的程度）。通过1)离散时间生存分析来检验依赖性与压力生活事件致抑郁效应之间的关系，以及2)双胞对照分析来检验压力生活事件与重性抑郁之间的关系。结果：独立的压力生活事件与抑郁症的发病有显著的相关性，当威胁水平受到控制时，依赖事件与抑郁症的发病有显著的相关性。在有压力的生活事件发生的那个月，所有受试者发生重度抑郁症的比值比为5.64，异卵组为4.52，同卵组为3.58。结论：有压力的生活事件与重性抑郁症发作的发生有重要的因果关系。然而，有压力的生活事件和抑郁发作之间的联系约有三分之一是非因果关系，因为易患抑郁症的人会选择高风险的环境。
Objective: Stressful life events are associated with the onset of episodes of major depression. However, exposure to stressful life events is influenced by genetic factors, and these factors are correlated with those that predispose to major depression. The aim of this study was to clarify the degree to which stressful life events cause major depression. Method: The authors assessed the occurrence of 15 classes of stressful life events and the onset of DSM-III-R major depression over a 1-year period in female twins ascertained from a population-based registry. The sample contained 24,648 person-months and 316 onsets of major depression. Stressful life events were individually rated on contextual threat and dependence (the degree to which the stressful life event could have resulted from the respondent's behavior). The nature of the relationship between stressful life events and major depression was tested by 1) discrete-time survival analysis examining the relationship between dependence and the depressogenic effect of stressful life events and 2) a co-twin control analysis. Results: While independent stressful life events were significantly associated with onsets of depression, when level of threat was controlled, the association was significantly stronger for dependent events. The odds ratio for onset of major depression in the month of a stressful life event was 5.64 in all subjects, 4.52 within dizygotic pairs, and 3.58 within monozygotic pairs. Conclusions: Stressful life events have a substantial causal relationship with the onset of episodes of major depression. However, about one-third of the association between stressful life events and onsets of depression is noncausal, since individuals predisposed to major depression select themselves into highrisk environments.