Chen L S, Eaton W W, Gallo J J, Nestadt G, Crum R M
Department of Mental Hygiene, School of Hygiene, Johns Hopkins University, Baltimore, MD 21205, USA.
Am J Psychiatry. 2000 Apr;157(4):573-80. doi: 10.1176/appi.ajp.157.4.573.
Research studies on the validity of current diagnostic and subthreshold categories of depression that use a population-based follow-up design are rare. The authors examined the validity and utility of four current depression categories by examining subject transition between categories and the symptoms, course, and risk factors of each.
A general population sample of 1,920 adults from the Baltimore Epidemiologic Catchment Area 13-year follow-up study were examined. Data on diagnoses, symptoms, course, and risk factors were collected by using the National Institute of Mental Health Diagnostic Interview Schedule, the Life Chart Interview, and an office visit. Polychotomous regression was used to examine the heterogeneity of four diagnostic categories: major depressive disorder, depressive syndrome, dysthymia, and a comorbid depression condition (major depressive disorder and dysthymia).
Transitions between the four depression categories occurred over the 13 years. Symptom profiles for the four categories were parallel but differed in severity. Course characteristics among the four categories slightly differed. Risk factor profiles showed significant differences. Family history was associated with both depressive syndrome and major depressive disorder. Stressful life events were most strongly associated with depressive syndrome. Female gender was most strongly associated with the comorbid depression category.
The evidence suggests that except for dysthymia, the depression categories are genetically homogeneous and environmentally heterogeneous. Stress is associated with mild depression, and gender is associated with severe depression. The apparent familial transmission of the subthreshold entity, depressive syndrome, needs further investigation.
采用基于人群的随访设计对当前抑郁症诊断及阈下类别有效性进行研究的情况较为少见。作者通过检查类别间的受试者转换以及每类的症状、病程和危险因素，对当前四种抑郁症类别进行了有效性和实用性检验。
对来自巴尔的摩流行病学集水区13年随访研究中的1920名成年人的总体样本进行了检查。使用美国国立精神卫生研究所诊断访谈表、生活图表访谈和门诊就诊收集有关诊断、症状、病程和危险因素的数据。采用多分类回归分析来检验四种诊断类别的异质性：重度抑郁症、抑郁综合征、恶劣心境以及共病性抑郁状态（重度抑郁症和恶劣心境）。
在这13年中，四种抑郁症类别之间发生了转换。四类的症状特征相似，但严重程度不同。四类之间的病程特征略有差异。危险因素特征显示出显著差异。家族史与抑郁综合征和重度抑郁症均相关。应激性生活事件与抑郁综合征关联最为密切。女性与共病性抑郁类别关联最为密切。
证据表明，除恶劣心境外，抑郁症类别在遗传上具有同质性，在环境方面具有异质性。应激与轻度抑郁症相关，而性别与重度抑郁症相关。阈下实体抑郁综合征明显的家族性传递需要进一步研究。
