Kendler Kenneth S, Hettema John M, Butera Frank, Gardner Charles O, Prescott Carol A
Virginia Institute for Psychiatry and Behavioral Genetics, Medical College of Virginia of Virginia Commonwealth University, Richmond, USA.
Arch Gen Psychiatry. 2003 Aug;60(8):789-96. doi: 10.1001/archpsyc.60.8.789.
Although substantial evidence suggests that stressful life events predispose to the onset of episodes of depression and anxiety, the essential features of these events that are depressogenic and anxiogenic remain uncertain.
High contextual threat stressful life events, assessed in 98 592 person-months from 7322 male and female adult twins ascertained from a population-based registry, were blindly rated on the dimensions of humiliation, entrapment, loss, and danger and their categories. Onsets of pure major depression (MD), pure generalized anxiety syndrome (GAS) (defined as generalized anxiety disorder with a 2-week minimum duration), and mixed MD-GAS episodes were examined using logistic regression.
Onsets of pure MD and mixed MD-GAS were predicted by higher ratings of loss and humiliation. Onsets of pure GAS were predicted by higher ratings of loss and danger. High ratings of entrapment predicted only onsets of mixed episodes. The loss categories of death and respondent-initiated separation predicted pure MD but not pure GAS episodes. Events with a combination of humiliation (especially other-initiated separation) and loss were more depressogenic than pure loss events, including death. No sex differences were seen in the prediction of episodes of illness by event categories.
In addition to loss, humiliating events that directly devalue an individual in a core role were strongly linked to risk for depressive episodes. Event dimensions and categories that predispose to pure MD vs pure GAS episodes can be distinguished with moderate specificity. The event dimensions that preceded mixed MD-GAS episodes were largely the sum of those that preceded pure MD and pure GAS episodes.
尽管大量证据表明，生活应激事件易引发抑郁和焦虑发作，但这些事件中导致抑郁和焦虑的基本特征仍不明确。
对从基于人群的登记处确定的7322名成年男女双胞胎进行了98592人月的评估，对高情境威胁性生活事件在羞辱、困境、损失和危险及其类别维度上进行盲评。使用逻辑回归分析纯重度抑郁症（MD）、纯广泛性焦虑综合征（GAS）（定义为持续至少2周的广泛性焦虑障碍）和混合性MD-GAS发作的发病情况。
纯MD和混合性MD-GAS发作可通过更高的损失和羞辱评分预测。纯GAS发作可通过更高的损失和危险评分预测。高困境评分仅预测混合发作的发病。死亡和受访者发起的分离等损失类别预测纯MD发作，但不预测纯GAS发作。兼具羞辱（尤其是他人发起的分离）和损失的事件比包括死亡在内的纯损失事件更易导致抑郁。事件类别对疾病发作的预测未发现性别差异。
除了损失外，那些直接贬低个体核心角色的羞辱性事件与抑郁发作风险密切相关。可中度特异性地区分易引发纯MD与纯GAS发作的事件维度和类别。混合性MD-GAS发作之前的事件维度在很大程度上是纯MD和纯GAS发作之前的事件维度之和。
