McDermut W, Mattia J, Zimmerman M
Rhode Island Hospital and Brown University School of Medicine, RI, USA.
J Affect Disord. 2001 Aug;65(3):289-95. doi: 10.1016/s0165-0327(00)00220-2.
Many studies have examined the co-occurrence of depression and one or two nondepressive disorders; however, little research has looked at broad spectrum comorbidity (i.e., comorbidity across several diagnostic categories) in depressed patients. Research on diagnostic practices in routine clinical settings--in which unstructured interviewing is the norm--suggests that comorbid conditions are often not detected [Zimmerman, M., Mattia, J. 1999. Psychiatric diagnosis in clinical practice: Is comorbidity being missed? Compr. Psychiatry, 40, 182-191]. In this study we examined the independent impact of different comorbid diagnostic categories on psychosocial morbidity in psychiatric outpatients with Major Depressive Disorder (MDD).
Participants were drawn from a pool of 1000 psychiatric outpatients interviewed with the Structured Clinical Interview for DSM-IV diagnoses (SCID-IV; [First, M.B., Spitzer, R.L., Williams, J.B.W., Gibbon, M., 1995. Structured Clinical Interview for DSM-IV (SCID). American Psychiatric Association, Washington, D.C.]). We compared the demographics, clinical characteristics, and psychosocial functioning of depressed outpatients with and without different axis I comorbidities, then conducted multivariate analyses to determine the respective impact of comorbid axis I disorders.
Three hundred and seventy-three patients had a principal diagnosis of unipolar MDD. One hundred twenty-nine (34.6%) were diagnosed with MDD only, and 244 (65.4%) had MDD and at least one other axis I disorder. Comorbidity was associated with longer duration of index episode, more psychiatric morbidity, and more social and occupational impairment. There was also a significant relationship between increasing number of comorbid axis I disorders and greater psychiatric and psychosocial impairment. In regression analyses, comorbidity burden (i.e., the number of comorbid axis I disorders) showed the strongest relation to psychiatric and psychosocial impairment.
This is not a random sample of depressed outpatients and, thus, may not be generalizable to all outpatients with depression. Second, Axes II and III comorbidity were not assessed.
Comorbidity burden showed the strongest relation to impairment over and above the presence of any particular class of disorders.
许多研究探讨了抑郁症与一两种非抑郁性疾病的共病情况；然而，很少有研究关注抑郁症患者的广泛共病现象（即跨多个诊断类别的共病）。对常规临床环境中诊断实践的研究（在这种环境中，非结构化访谈是常态）表明，共病情况往往未被发现[齐默尔曼，M.，马蒂亚，J. 1999。临床实践中的精神科诊断：共病是否被漏诊？《综合精神病学》，40，182 - 191]。在本研究中，我们考察了不同共病诊断类别对重度抑郁症（MDD）精神科门诊患者心理社会发病情况的独立影响。
研究对象来自1000名接受《精神疾病诊断与统计手册》第四版（DSM - IV）诊断的结构化临床访谈（SCID - IV；[第一，M.B.，斯皮策，R.L.，威廉姆斯，J.B.W.，吉本，M.，1995。《精神疾病诊断与统计手册》第四版结构化临床访谈（SCID）。美国精神病学协会，华盛顿特区]）的精神科门诊患者。我们比较了有和没有不同轴I共病的抑郁症门诊患者的人口统计学特征、临床特征及心理社会功能，然后进行多变量分析以确定轴I共病障碍各自的影响。
373名患者的主要诊断为单相重度抑郁症。129名（34.6%）仅被诊断为重度抑郁症，244名（65.4%）患有重度抑郁症且至少有一种其他轴I障碍。共病与首发发作持续时间更长、更多的精神疾病发病情况以及更多的社会和职业功能损害相关。轴I共病障碍数量增加与更严重的精神和心理社会损害之间也存在显著关系。在回归分析中，共病负担（即轴I共病障碍的数量）与精神和心理社会损害的关系最为密切。
这不是抑郁症门诊患者的随机样本，因此可能不适用于所有抑郁症门诊患者。其次，未评估轴II和轴III共病情况。
共病负担与损害的关系最为密切，超过了任何特定类别疾病的存在所产生的影响。
