JAMA. 1992 Dec 2;268(21):3098-105. doi: 10.1001/jama.1992.03490210080039.
To estimate temporal trends in the rates of major depression cross-nationally.
Nine epidemiologic surveys and three family studies.
Approximately 39,000 subjects in population-based samples from nine epidemiologic surveys, and 4000 relatives from three family studies that were conducted independently but using similar methodology in the 1980s in North America, Puerto Rico, Western Europe, the Middle East, Asia, and the Pacific Rim.
Age at first onset of major depression by birth cohort and time period.
There was an increase in the cumulative lifetime rates of major depression with each successively younger birth cohort at all sites with the exception of the Hispanic samples, in whom the rates in the older cohort (1915 through 1935) were approximately equal to those of the younger cohorts. However, results of fitting statistical models that separate period and cohort effects showed an overall increase in the rates of major depression over time over all countries, although the magnitude of the increase varied by country. The average relative risk of major depression between a particular cohort and the cohort born immediately before varied between 2.6 (95% confidence interval, 1.8 to 3.7) in Florence, Italy, and 1.3 (95% confidence interval, 1.2 to 1.4) in Christchurch, New Zealand. Short-term fluctuations in the rates of major depression during specific time periods and in specific cohorts also varied by country.
Cross-nationally, the more recent birth cohorts are at increased risk for major depression. There are, however, variations in the long- and short-term trends for major depression by country, which suggests that the rates in these countries may have been affected by differing historical, social, economic, or biological environmental events. The linking of demographic, epidemiologic, economic, and social indices by country to these changes may clarify environmental conditions that influence the rates of major depression.
评估全球范围内重度抑郁症发病率随时间的变化趋势。
九项流行病学调查和三项家族研究。
九项流行病学调查中基于人群样本的约39000名受试者，以及三项家族研究中的4000名亲属。这些研究于20世纪80年代在北美、波多黎各、西欧、中东、亚洲和环太平洋地区独立开展，但采用了相似的方法。
按出生队列和时间段划分的重度抑郁症首次发病年龄。
除西班牙裔样本外，所有地区的重度抑郁症累积终生发病率均随着出生队列逐渐变年轻而上升，在西班牙裔样本中，较老队列（1915年至1935年）的发病率与较年轻队列大致相当。然而，对区分时期效应和队列效应的统计模型进行拟合的结果显示，尽管各国发病率上升幅度不同，但所有国家的重度抑郁症发病率总体上随时间呈上升趋势。在意大利佛罗伦萨，特定队列与紧挨着的前一个队列相比，重度抑郁症的平均相对风险在2.6（95%置信区间为1.8至3.7）之间；在新西兰克赖斯特彻奇，这一数值为1.3（95%置信区间为1.2至1.4）。特定时期和特定队列中重度抑郁症发病率的短期波动也因国家而异。
在全球范围内，较近出生队列患重度抑郁症的风险增加。然而，各国重度抑郁症的长期和短期趋势存在差异，这表明这些国家的发病率可能受到不同的历史、社会、经济或生物环境事件的影响。将各国的人口统计学、流行病学、经济和社会指标与这些变化联系起来，可能会阐明影响重度抑郁症发病率的环境条件。
