Mundt C, Reck C, Backenstrass M, Kronmüller K, Fiedler P
Psychiatric Hospital of the University of Heidelberg, Germany.
J Affect Disord. 2000 Jul;59(1):23-30. doi: 10.1016/s0165-0327(99)00127-5.
Since the 1960s the association of stressful life events and depression seemed to be firmly established. However, a few recent studies did not confirm those earlier findings. One of the reasons discussed for the inconsistencies was the sampling of milder depressed neurotic out-patients in the earlier studies vs. more severely ill endogenous type in-patients in recent studies.
This investigation was carried out with 50 consecutively admitted in-patients with endogenous depression according to ICD 9 and unipolar major depression according to DSM-III-R as ascertained by SCID. The control sample consisted of 26 healthy volunteers. Life events and chronic distressing life conditions were recorded with the Munich Interview for the Assessment of Life Events and Conditions (MEL) every 3 months over a period of 2 years along with psychopathological symptoms and recurrencies. Hence the design was prospective in the sense that life events were recorded for one 3-month cross-section, the depressive reaction for the subsequent one. BDI scores taken at the respective cross section were used to control for depressive bias of the subjective part of the patient's life event evaluation.
Three months prior to the index hospitalization patients were more often affected by life events and conditions than controls. The number of stressful conditions prior to the index hospitalization indicated the time to relapse after discharge. Controls showed more desirable positive conditions than patients. Relapse patients suffered more often stressful life events and conditions than non-relapsers 3 months prior to their relapse. Multivariate analysis indicates that the cumulative number of life events within the 2-year course is the best predictor of the BDI score at the end of the follow-up period.
Since the subjective component of life event assessment by MEL displayed a higher impact on the course of depression than the objective part of the assessment, confounding of subjective ratings, attributional styles, and depressive symptoms may be a problem although controlled for in this study.
The results support the importance of stressful life events and chronic distressing conditions for the 2-year course and outcome of major depression in an in-patient sample. Since the overall consistency of significant results was more pronounced in the subjective than in the objective part of the MEL the results fit best a circular pathogenetic model of interactions between life events, their individual evaluation by the patient, and depressive symptoms.
自20世纪60年代以来，应激性生活事件与抑郁症之间的关联似乎已被牢固确立。然而，最近的一些研究并未证实这些早期发现。对于这些不一致性所讨论的原因之一是，早期研究中选取的是病情较轻的抑郁性神经症门诊患者，而最近的研究中选取的是病情更严重的内源性类型的住院患者。
本研究对50例根据国际疾病分类第9版（ICD 9）诊断为内源性抑郁症且根据精神疾病诊断与统计手册第三版修订版（DSM-III-R）诊断为单相重度抑郁症的连续入院患者进行了调查，这些诊断由结构化临床访谈（SCID）确定。对照样本由26名健康志愿者组成。使用慕尼黑生活事件与状况评估访谈（MEL），在2年的时间里，每3个月记录一次生活事件和慢性困扰性生活状况，同时记录心理病理症状和复发情况。因此，从某种意义上说，该设计是前瞻性的，即记录一个3个月时间段内的生活事件，记录随后一个时间段内的抑郁反应。在各个时间段所取的贝克抑郁量表（BDI）分数用于控制患者生活事件评估主观部分的抑郁偏差。
在首次住院前3个月，患者比对照组更频繁地受到生活事件和状况的影响。首次住院前应激状况的数量表明出院后的复发时间。对照组比患者表现出更多令人满意的积极状况。复发患者在复发前3个月比未复发患者更频繁地遭受应激性生活事件和状况。多变量分析表明，2年病程中生活事件的累积数量是随访期末BDI分数的最佳预测指标。
由于MEL对生活事件评估的主观成分对抑郁病程的影响大于评估的客观部分，尽管本研究对此进行了控制，但主观评分、归因方式和抑郁症状的混淆可能是一个问题。
研究结果支持了应激性生活事件和慢性困扰状况对住院患者样本中重度抑郁症2年病程和结局的重要性。由于MEL主观部分显著结果的总体一致性比客观部分更明显，因此研究结果最符合生活事件、患者对其个体评估以及抑郁症状之间相互作用的循环致病模型。
