Oldehinkel A J, Wittchen H U, Schuster P
Max Planck Institute of Psychiatry, Clinical Psychology and Epidemiology Unit, Munich, Germany.
Psychol Med. 1999 May;29(3):655-68. doi: 10.1017/s0033291799008454.
This article presents prospective longitudinal findings on prevalence, incidence, patterns of change and stability of depressive disorders in a community sample of 1228 adolescents.
Data were collected at baseline and follow-up (20 months later) in a representative population sample of 1228 adolescents, aged 14-17 at baseline. Diagnostic assessment was based on the Munich Composite International Diagnostic Interview (M-CIDI).
The overall cumulative lifetime incidence of any depressive condition was 20.0% (major depressive disorder (MDD), 12.2%; dysthymia, 3-5%; subthreshold MDD, 6.3%), of which about one-third were incident depressions in the period between baseline and follow-up. Depressive disorders rarely started before the age of 13. Females were about twice as likely as males to develop a depressive disorder. Overall, the 20-month outcome of baseline depression was unfavourable. Dysthymia had the poorest outcome of all, with a complete remission rate of only 33% versus 43% for MDD and 54% for subthreshold MDD. Dysthymia also had the highest number of depressive episodes, and most psychosocial impairment and suicidal behavioural during follow-up. Treatment rates were low (8-23%). Subthreshold MDD associated with considerable impairment had an almost identical course and outcome as threshold MDD.
DSM-IV MDD and dysthymia are rare before the age of 13, but frequent during adolescence, with an estimated lifetime cumulative incidence of 14%. Only a minority of these disorders in adolescence is treated, and more than half of them persist or remit only partly.
本文呈现了对1228名青少年社区样本中抑郁症的患病率、发病率、变化模式及稳定性的前瞻性纵向研究结果。
对1228名基线年龄为14 - 17岁的青少年代表性人群样本在基线和随访时（20个月后）收集数据。诊断评估基于慕尼黑综合国际诊断访谈（M - CIDI）。
任何抑郁状况的总体终生累积发病率为20.0%（重度抑郁症（MDD），12.2%；心境恶劣障碍，3 - 5%；阈下MDD，6.3%），其中约三分之一是基线至随访期间的新发抑郁症。抑郁症很少在13岁之前发病。女性患抑郁症的可能性约为男性的两倍。总体而言，基线抑郁症20个月后的转归不佳。心境恶劣障碍的转归最差，完全缓解率仅为33%，而MDD为43%，阈下MDD为54%。心境恶劣障碍在随访期间的抑郁发作次数也最多，心理社会损害和自杀行为也最多。治疗率较低（8 - 23%）。伴有相当程度损害的阈下MDD与阈上MDD的病程和转归几乎相同。
DSM - IV的MDD和心境恶劣障碍在13岁之前很少见，但在青少年期很常见，估计终生累积发病率为14%。青少年期这些疾病中只有少数得到治疗，且超过一半会持续存在或仅部分缓解。
