Substance use disorder comorbidity in major depressive disorder: An exploratory analysis of the Sequenced Treatment Alternatives to Relieve Depression cohort
Substance use disorder comorbidity in major depressive disorder: An exploratory analysis of the Sequenced Treatment Alternatives to Relieve Depression cohort
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DOI：
10.1016/j.comppsych.2004.07.025
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发表时间：
2005-03-01
影响因子：
7.3
通讯作者：
McGrath, PJ
中科院分区：
文献类型：
--
作者：
Davis, LL;Rush, JA;McGrath, PJ
重性抑郁症（MDD）患者经常出现并发物质使用障碍（SUD），涉及酒精和/或非法药物。该分析比较了患有MDD且并发SUD症状的患者与没有SUD症状的患者的抑郁症状表现以及一系列临床和人口统计学特征，以阐明这两者的不同之处，并确定并发SUD症状是否可能改变MDD的临床表现。第一个1500名非精神病性MDD门诊患者参加了序贯治疗替代方案，以缓解抑郁症的研究分为那些有和没有并发SUD症状的自我报告工具，精神病诊断筛选问卷（PDSQ）确定。在完成基线PDSQ的1484例病例中，发现28%（n = 419）的MDD患者支持与当前SUD一致的症状。与没有SUD症状的患者相比，有SUD症状的患者更可能是男性（P <0.0001），离婚或从未结婚（P <0.018），抑郁症发病年龄更小（P = 0.014），既往自杀企图率更高（P = 0.014）。与没有并发SUD症状的患者相比，有SUD症状的重度抑郁症患者因其疾病而导致的功能障碍更大（P = 0.0111）。SUD症状的存在并没有改变总体抑郁症状的表现模式，除了双重诊断的患者与没有SUD症状的患者相比有更高水平的嗜睡（P = 0.006），焦虑情绪（P = 0.047）和自杀意念（P = 0.036）。总之，性别，婚姻状况，抑郁症发病年龄，功能障碍，自杀危险因素在抑郁症患者并发SUD症状相比，那些没有SUD合并症。(c)2005年爱思唯尔公司All rights reserved.
Patients with major depressive disorder (MDD) often present with concurrent substance use disorders (SUD) involving alcohol and/or illicit drugs. This analysis compares the depressive symptomatic presentation and a range of clinical and demographic features of patients with MDD and concurrent SUD symptoms vs those without SUD symptoms, to clarify how these two differ and to determine whether concurrent SUD symptoms may alter the clinical presentation of MDD. The first 1500 outpatients with nonpsychotic MDD enrolled in the Sequenced Treatment Alternatives to Relieve Depression study were divided into those with and without concurrent SUD symptoms as ascertained by a self-report instrument, the Psychiatric Diagnostic Screening Questionnaire (PDSQ). Of the 1484 cases with completed baseline PDSQ, 28% (n = 419) of patients with MDD were found to endorse symptoms consistent with current SUD. Patients with symptoms consistent with SUD were more likely to be men (P < .0001), to be either divorced or never married (P < .018), to have a younger age of onset of depression ( P = .014), and to have a higher rate of previous suicide attempts ( P = .014) than those without SUD symptoms. Patients with major depressive disorder who have symptoms consistent with SUD endorsed greater functional impairment attributable to their illness than those without concurrent SUD symptoms (P = .0111). The presence of SUD symptoms did not alter the overall depressive symptom pattern of presentation, except that the dual-diagnosed patients had higher levels of hypersomnia (P = .006), anxious mood (P = .047), and suicidal ideation (P = .036) compared to those without SUD symptoms. In conclusion, gender, marital status, age of onset of major depression, functional impairment, and suicide risk factors differ in depressed patients with concurrent SUD symptoms compared to those without SUD comorbidity. (c) 2005 Elsevier Inc. All rights reserved.