Mazure C M, Bruce M L, Maciejewski P K, Jacobs S C
Department of Psychiatry and Donaghue Women's Health Investigator Program, Yale University, New Haven, CT 06520, USA.
Am J Psychiatry. 2000 Jun;157(6):896-903. doi: 10.1176/appi.ajp.157.6.896.
Stressful life events are known to precipitate major depression. However, it remains unclear why some individuals who experience adverse events develop depression whereas others do not, and how the occurrence of life events affects treatment outcome. Emerging models posit that the effect of adverse life events varies by cognitive-personality style. This study examines the direct and interactive effects of stressful life events and cognitive-personality style in predicting 1) episode onset in patients with DSM-IV unipolar depression versus community comparison subjects and 2) depressive symptom severity at the completion of a 6-week standard antidepressant regimen.
Multivariate models were used to test the effects of adverse life events, cognitive-personality style, and the congruence of event type (interpersonal versus achievement) with cognitive-personality style on depressive onset and treatment outcome in 43 patients with major depression and 43 healthy comparison subjects. Cognitive-personality characteristics were assessed by using Beck's measures of sociotropy (interpersonal dependency) and autonomy (need for independence and control).
Adverse life events, sociotropy, and an autonomy factor need for control were each significantly related to depressive onset and predicted group status for 88% of the subjects. Event types affected outcome differently, and specific life event types interacted with cognitive-personality styles in predicting response to treatment. A multivariate model accounted for 65% of the variance in predicting outcome.
Adverse life events are a potent factor in predicting depression. However, cognitive-personality characteristics also confer susceptibility to depression. Better outcome is associated with occurrence of adverse interpersonal events (e.g., death of a loved one) rather than adverse achievement events (e.g., loss of job) and occurs when the event type is congruent with cognitive-personality style.
已知生活应激事件会引发重度抑郁症。然而,仍不清楚为何一些经历不良事件的个体患上抑郁症,而另一些人却没有,以及生活事件的发生如何影响治疗结果。新出现的模型认为,不良生活事件的影响因认知 - 人格风格而异。本研究考察了生活应激事件和认知 - 人格风格在预测以下两方面的直接和交互作用:1)与社区对照对象相比,DSM - IV 单相抑郁症患者的发作情况;2)在完成为期 6 周的标准抗抑郁治疗方案时的抑郁症状严重程度。
采用多变量模型来检验不良生活事件、认知 - 人格风格以及事件类型(人际型与成就型)与认知 - 人格风格的一致性对 43 例重度抑郁症患者和 43 例健康对照对象的抑郁发作及治疗结果的影响。通过使用贝克的社会依赖(人际依赖)和自主性(对独立和控制的需求)测量方法来评估认知 - 人格特征。
不良生活事件、社会依赖以及自主性因素对控制的需求均与抑郁发作显著相关,并且能预测 88%受试者的分组情况。事件类型对结果的影响不同,特定的生活事件类型在预测治疗反应时与认知 - 人格风格相互作用。一个多变量模型解释了预测结果中 65%的方差。
不良生活事件是预测抑郁症的一个重要因素。然而,认知 - 人格特征也使人易患抑郁症。更好的治疗结果与不良人际事件(如亲人死亡)而非不良成就事件(如失业)的发生相关,并且当事件类型与认知 - 人格风格一致时会出现较好的治疗结果。