Oldehinkel Albertine J, Van Den Berg Marjan D, Bouhuys Antoinette L, Ormel Johan
Department of Psychiatry, University of Groningen, The Netherlands.
Depress Anxiety. 2003;18(2):67-75. doi: 10.1002/da.10116.
The vulnerability-accumulation (or scarring) hypothesis postulates that the experience of depression induces a lasting increase in vulnerability, and through this raises the risk of recurrence. We examined the validity of the vulnerability-accumulation model for depressive episodes in later life. The sample comprised 26 elderly persons who had remitted from a depressive episode and 96 control respondents who were all selected from the participants of a large community survey among persons aged 57 years or more. Several psychosocial vulnerability indicators were assessed premorbidly, during the depressive episode and after remission. High levels of psychological distress, low life satisfaction, chronic somatic diseases, high neuroticism, and low scores on extraversion, mastery, and self-efficacy appeared to be predictors of depression in this sample. During the depressive episode, psychological distress was higher and life satisfaction, physical, role, and social functioning, as well as feelings of self-efficacy lower than before the episode. Physical and role functioning, cognitive function, and self-efficacy were lower after remission compared to premorbid levels, but (other) personality indices had not changed after remission compared to premorbid levels. Furthermore, we failed to find differences between first and recurrent episodes. Support for the vulnerability-accumulation model was limited at the most. Although psychosocial scarring may occur in the elderly, our findings tentatively suggest that this accumulation does not manifest itself in major vulnerability indicators such as neuroticism.
易感性累积（或瘢痕化）假说假定，抑郁症发作经历会导致易感性持续增加，进而增加复发风险。我们检验了易感性累积模型对晚年抑郁发作的有效性。样本包括26名从抑郁发作中康复的老年人以及96名对照受访者，他们均选自一项针对57岁及以上人群的大型社区调查的参与者。在病前、抑郁发作期间及缓解后评估了多个心理社会易感性指标。在该样本中，高水平的心理困扰、低生活满意度、慢性躯体疾病、高神经质以及外向性、掌控感和自我效能感得分低似乎是抑郁症的预测因素。在抑郁发作期间，心理困扰比发作前更高，而生活满意度、身体、角色和社会功能以及自我效能感比发作前更低。与病前水平相比，缓解后身体和角色功能、认知功能以及自我效能感更低，但与病前水平相比，（其他）人格指标在缓解后并未改变。此外，我们未发现首次发作和复发之间存在差异。对易感性累积模型的支持最多也很有限。尽管心理社会瘢痕化可能在老年人中发生，但我们的研究结果初步表明，这种累积并未在诸如神经质等主要易感性指标中表现出来。
