Kessler Ronald C
Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Suite 215, Boston, MA 02115-5899, USA.
J Affect Disord. 2003 Mar;74(1):5-13. doi: 10.1016/s0165-0327(02)00426-3.
Depression is the leading cause of disease-related disability among women in the world today. Depression is much more common among women than men, with female/male risk ratios roughly 2:1.
Recent epidemiological research is reviewed. Implications are suggested for needed future research.
The higher prevalence of depression among women than men is due to higher risk of first onset, not to differential persistence or recurrence. Although the gender difference first emerges in puberty, other experiences related to changes in sex hormones (pregnancy, menopause, use of oral contraceptives, and use of hormone replacement therapy) do not significantly influence major depression. These observations suggest that the key to understanding the higher rates of depression among women than men lies in an investigation of the joint effects of biological vulnerabilities and environmental provoking experiences.
Advancing understanding of female depression will require future epidemiologic research to focus on first onsets and to follow incident cohorts of young people through the pubertal transition into young adulthood with fine-grained measures of both sex hormones and gender-related environmental experiences. Experimental interventions aimed at primary prevention by jointly manipulating putative biological and environmental risk factors will likely be needed to adjudicate between contending causal hypotheses regarding the separate and joint effects of interrelated risk factors.
抑郁症是当今世界女性中与疾病相关残疾的主要原因。抑郁症在女性中比男性更为常见，女性与男性的风险比约为2:1。
综述近期的流行病学研究。对未来所需研究提出建议。
女性抑郁症患病率高于男性是由于首次发病风险较高，而非持续或复发情况的差异。尽管性别差异在青春期首次出现，但与性激素变化相关的其他经历（怀孕、更年期、使用口服避孕药和使用激素替代疗法）对重度抑郁症并无显著影响。这些观察结果表明，理解女性抑郁症发病率高于男性的关键在于调查生物易感性和环境激发经历的共同作用。
要进一步了解女性抑郁症，未来的流行病学研究需要关注首次发病情况，并通过对性激素和与性别相关的环境经历进行细致测量，追踪年轻人从青春期过渡到青年期的发病队列。可能需要通过联合操纵假定的生物和环境风险因素进行一级预防的实验性干预措施，以判定关于相互关联风险因素的单独和共同作用的相互竞争因果假设。
