Wise L A, Zierler S, Krieger N, Harlow B L
Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Lancet. 2001 Sep 15;358(9285):881-7. doi: 10.1016/S0140-6736(01)06072-X.
Major depressive disorder is a significant cause of morbidity among women in the USA. Women are twice as likely as men to be diagnosed with major depressive disorder, yet no known risk factors can account for this sex difference. We aimed to assess violent victimisation as a risk factor for depression in women.
We undertook a case-control study to assess the association between violent victimisation early in life and major depressive disorder in women. We randomly selected a population-based sample of women, aged 36-45 years, from the greater Boston area. In 1999, 236 cases and 496 controls (n=732) completed a self-administered questionnaire designed to ascertain a lifetime history of exposure to violent victimisation. Our main outcome measure was major depressive disorder, assessed by structured clinical interview for Diagnostic Statistical Manual IV (DSM-IV) criteria.
363 (50%) of 732 respondents reported experience or fear of abuse as a child or adolescent. 68 were excluded because they reported violence as an adult only. Compared with women who reported no abuse, risk of depression was increased in women who reported any abuse as a child or adolescent (relative risk 2.5, 95% CI 1.9-3.0), physical abuse only (2.4, 1.8-3.0), sexual abuse only (1.8, 1.2-2.8), and both physical and sexual abuse (3.3, 2.5-4.1). Severity of abuse had a linear dose-response relation with depression.
Our results suggest a positive association between violent victimisation early in life and major depressive disorder in women.
在美国，重度抑郁症是女性发病的一个重要原因。女性被诊断为重度抑郁症的可能性是男性的两倍，但尚无已知风险因素能解释这种性别差异。我们旨在评估暴力受害经历作为女性抑郁症的一个风险因素。
我们进行了一项病例对照研究，以评估早年暴力受害经历与女性重度抑郁症之间的关联。我们从大波士顿地区基于人群随机抽取了36 - 45岁的女性样本。1999年，236例病例和496名对照（共732人）完成了一份自我管理问卷，旨在确定一生当中遭受暴力受害的经历。我们的主要结局指标是重度抑郁症，通过依据《诊断统计手册第四版》（DSM - IV）标准进行的结构化临床访谈来评估。
732名受访者中有363人（50%）报告在儿童或青少年时期有过受虐待经历或对此感到恐惧。68人因仅报告成年后遭受暴力而被排除。与未报告受虐待的女性相比，报告在儿童或青少年时期有任何形式虐待的女性患抑郁症的风险增加（相对风险2.5，95%置信区间1.9 - 3.0），仅遭受身体虐待的女性（2.4，1.8 - 3.0），仅遭受性虐待的女性（1.8，1.2 - 2.8），以及同时遭受身体和性虐待的女性（3.3，2.5 - 4.1）。虐待的严重程度与抑郁症存在线性剂量反应关系。
我们的结果表明，女性早年暴力受害经历与重度抑郁症之间存在正相关。
