Chen L, Eaton W W, Gallo J J, Nestadt G
Department of Mental Hygiene, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
J Affect Disord. 2000 Jul;59(1):1-11. doi: 10.1016/s0165-0327(99)00132-9.
There is an ongoing research effort to test if depression is a homogeneous clinical syndrome and to identify valid and useful subtypes based on the number and nature of depressive symptoms. This study summarizes the patterns of depressive symptoms evident in a prospective study of the general population and examines the validity of potential subtypes by studying their course and etiologic heterogeneity.
A general population sample of 1920 adults (aged 18-96) from the Baltimore Epidemiologic Catchment Area (ECA) follow-up study (1981 to 1993/6) were examined. Data on diagnoses, symptoms, course and risk factors were collected using the Diagnostic Interview Schedule (DIS). Latent class analysis was applied to summarize symptom patterns. Course characteristics and risk factor profiles were compared among potential subtypes based on the number of symptom groups or symptom patterns. Logistic regression models were used to examine the etiologic heterogeneity among potential subtypes based on symptoms.
The number of symptom groups gave the most efficient insight into differential etiologic processes. Severe depression (7-9 symptom groups) was associated with female gender, family history of depression but not with stressful life events before the onset of the first episode. Moderate (5-6 symptom groups) and mild depression (3-4 symptom groups) were associated with family history of depression, stressful life events before the onset, but not with female gender. The latent class model generated patterns of depressive psychopathology as follows: anhedonia, suicidal, psychomotor, and severely depressed subtypes. The Anhedonia subtype showed a course and risk factor profile distinct from the others.
The measurement of psychopathology was based on self-reported DIS interviews instead of psychiatric assessments. Recall or report bias cannot be excluded in the ascertainment of family history and stressful life events.
Depression is heterogeneous, even below the threshold of syndromal diagnosis. The severity of an episode appears to be more informative than the pattern of symptoms, with the possible exception of a putative anhedonic subtype.
目前正在进行一项研究，以检验抑郁症是否为一种同质的临床综合征，并根据抑郁症状的数量和性质确定有效且有用的亚型。本研究总结了在一项针对普通人群的前瞻性研究中明显的抑郁症状模式，并通过研究其病程和病因异质性来检验潜在亚型的有效性。
对来自巴尔的摩流行病学集水区（ECA）随访研究（1981年至1993/6年）的1920名成年人（年龄在18 - 96岁）的普通人群样本进行了检查。使用诊断访谈表（DIS）收集有关诊断、症状、病程和危险因素的数据。应用潜在类别分析来总结症状模式。根据症状组或症状模式的数量，比较潜在亚型之间的病程特征和危险因素概况。使用逻辑回归模型来检验基于症状的潜在亚型之间的病因异质性。
症状组的数量能最有效地洞察不同的病因过程。重度抑郁症（7 - 9个症状组）与女性性别、抑郁症家族史相关，但与首次发作前的应激性生活事件无关。中度（5 - 6个症状组）和轻度抑郁症（3 - 4个症状组）与抑郁症家族史、发作前的应激性生活事件相关，但与女性性别无关。潜在类别模型产生了以下抑郁精神病理学模式：快感缺失型、自杀型、精神运动型和重度抑郁型亚型。快感缺失型亚型显示出与其他亚型不同的病程和危险因素概况。
精神病理学的测量基于自我报告的DIS访谈，而非精神病学评估。在确定家族史和应激性生活事件时，不能排除回忆或报告偏差。
抑郁症是异质性的，即使在综合征诊断阈值以下也是如此。除了可能存在的假定快感缺失型亚型外，发作的严重程度似乎比症状模式更具信息量。
