Psychosocial stressors and the prognosis of major depression: a test of Axis IV.
Psychosocial stressors and the prognosis of major depression: a test of Axis IV.
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DOI：
10.1017/s0033291712001080
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发表时间：
2013-02
影响因子：
6.9
通讯作者：
Breslau, J.
中科院分区：
文献类型：
--
作者：
Gilman, S. E.;Trinh, N. -H.;Smoller, J. W.;Fava, M.;Murphy, J. M.;Breslau, J.
第四轴用于报告“可能影响精神疾病的诊断、治疗和预后的心理社会和环境问题”。目前还没有研究检验DSM-IV中轴IV的预后价值。我们分析了2,497名参加全国酒精及相关疾病严重抑郁发作(MDE)流行病学调查的参与者的数据。我们假设心理社会应激源预示着MDE的不良预后。其次，我们假设心理社会应激源预测焦虑和物质使用障碍的不良预后。应激源根据DSM-IV的分类进行定义，并使用潜在类别分析进行实证研究。主要的支持团体问题、职业问题和童年逆境使抑郁发作和自杀意念的风险增加了20%-30%。根据经验得出的压力源类别与抑郁的关联度更大。经济压力使抑郁发作的风险增加1.5倍(CI=1.2-1.9)；经济和人际不稳定导致复发抑郁的风险增加1.3倍(CI=1.1-1.6)。这两类压力源还可以预测焦虑和物质使用障碍的复发。应激源与自杀意念无关，与抑郁严重程度无关。心理社会和环境问题与MDE和其他I型轴疾病的预后有关。虽然DSM-IV对应激源的分类有待改进，但这些结果为Axis IV的预后价值提供了经验支持。进一步的工作需要确定Axis IV评估在临床实践中的可靠性，以及这些信息对改善精神障碍的临床病程的有效性。
Axis IV is for reporting “psychosocial and environmental problems that may affect the diagnosis, treatment, and prognosis of mental disorders.” No studies have examined the prognostic value of Axis IV in DSM-IV. We analyzed data from 2,497 participants in the National Epidemiologic Survey on Alcohol and Related Conditions with major depressive episode (MDE). We hypothesized that psychosocial stressors predict a poor prognosis of MDE. Secondarily, we hypothesized that psychosocial stressors predict a poor prognosis of anxiety and substance use disorders. Stressors were defined according to DSM-IV’s taxonomy, and empirically using latent class analysis. Primary support group problems, occupational problems, and childhood adversity increased the risks of depressive episodes and suicidal ideation by 20–30%. Associations of the empirically derived classes of stressors with depression were larger in magnitude. Economic stressors conferred a 1.5-fold increase in risk for a depressive episode (CI=1.2–1.9); financial and interpersonal instability conferred a 1.3-fold increased risk of recurrent depression (CI=1.1–1.6). These two classes of stressors also predicted the recurrence of anxiety and substance use disorders. Stressors were not related to suicidal ideation independent from depression severity. Psychosocial and environmental problems are associated with the prognosis of MDE and other Axis I disorders. Though DSM-IV’s taxonomy of stressors stands to be improved, these results provide empirical support for the prognostic value of Axis IV. Future work is needed to determine the reliability of Axis IV assessments in clinical practice, and the usefulness of this information to improving the clinical course of mental disorders.