Andrade Laura, Caraveo-Anduaga Jorge J, Berglund Patricia, Bijl Rob V, De Graaf Ron, Vollebergh Wilma, Dragomirecka Eva, Kohn Robert, Keller Martin, Kessler Ronald C, Kawakami Norito, Kiliç Cengiz, Offord David, Ustun T Bedirhan, Wittchen Hans-Ulrich
Institute and Department of Psychiatry, School of Medicine, University of São Paulo, Brazil.
Int J Methods Psychiatr Res. 2003;12(1):3-21. doi: 10.1002/mpr.138.
Absence of a common diagnostic interview has hampered cross-national syntheses of epidemiological evidence on major depressive episodes (MDE). Community epidemiological surveys using the World Health Organization Composite International Diagnostic Interview administered face-to-face were carried out in 10 countries in North America (Canada and the US), Latin America (Brazil, Chile, and Mexico), Europe (Czech Republic, Germany, the Netherlands, and Turkey), and Asia (Japan). The total sample size was more than 37,000. Lifetime prevalence estimates of hierarchy-free DSM-III-R/DSM-IV MDE varied widely, from 3% in Japan to 16.9% in the US, with the majority in the range of 8% to 12%. The 12-month/lifetime prevalence ratio was in the range 40% to 55%, the 30-day/12-month prevalence ratio in the range 45% to 65%, and median age of onset in the range 20 to 25 in most countries. Consistent socio-demographic correlates included being female and unmarried. Respondents in recent cohorts reported higher lifetime prevalence, but lower persistence than those in earlier cohorts. Major depressive episodes were found to be strongly co-morbid with, and temporally secondary to, anxiety disorders in all countries, with primary panic and generalized anxiety disorders the most powerful predictors of the first onset of secondary MDE. Major depressive episodes are a commonly occurring disorder that usually has a chronic-intermittent course. Effectiveness trials are needed to evaluate the impact of early detection and treatment on the course of MDE as well as to evaluate whether timely treatment of primary anxiety disorders would reduce the subsequent onset, persistence, and severity of secondary MDE.
缺乏通用的诊断访谈阻碍了对重度抑郁发作（MDE）的流行病学证据进行跨国综合分析。在北美洲（加拿大和美国）、拉丁美洲（巴西、智利和墨西哥）、欧洲（捷克共和国、德国、荷兰和土耳其）以及亚洲（日本）的10个国家开展了社区流行病学调查，采用世界卫生组织综合国际诊断访谈进行面对面访谈。总样本量超过37000。无层次的DSM-III-R/DSM-IV MDE的终生患病率估计差异很大，从日本的3%到美国的16.9%，大多数在8%至12%的范围内。12个月/终生患病率比在40%至55%之间，30天/12个月患病率比在45%至65%之间，大多数国家的发病年龄中位数在20至25岁之间。一致的社会人口统计学相关因素包括女性和未婚。与早期队列中的受访者相比，近期队列中的受访者报告的终生患病率更高，但持续性更低。在所有国家，重度抑郁发作被发现与焦虑症强烈共病且在时间上继发于焦虑症，原发性惊恐障碍和广泛性焦虑障碍是继发性MDE首次发作的最有力预测因素。重度抑郁发作是一种常见疾病，通常呈慢性间歇性病程。需要进行有效性试验，以评估早期检测和治疗对MDE病程的影响，以及评估原发性焦虑症的及时治疗是否会减少继发性MDE的后续发作、持续性和严重程度。
