Kruijshaar M E, Hoeymans N, Bijl R V, Spijker J, Essink-Bot M L
Department for Public Health Forecasting, National Institute of Public Health and the Environment, Bilthoven, The Netherlands.
J Affect Disord. 2003 Oct;77(1):53-64. doi: 10.1016/s0165-0327(02)00099-x.
Information on the distribution of disability associated with major depression (MD) across different groups of patients is of interest to health policy and planning. We examined the associations of severity and type (a single or recurrent episode) of MD with disability in a Dutch general population sample.
We used data from the first wave (1996) of the Netherlands Mental Health Survey and Incidence Study (NEMESIS). MD 'severity' and 'type' were diagnosed with the help of the Composite International Diagnostic Interview according to DSM-III-R criteria. SF-36 scores, days ill in bed and days absent from work were taken as indicators of disability. The differences in these variables were studied by means of variance and regression analysis.
Recurrent MD was found not to be associated with more disability than single episode MD. Higher 'severity' classes were associated with more disability. However, the degree of disability between 'moderate' and 'severe' MD differed only very slightly. The difference in disability between non-depressed and mildly depressed individuals had a larger effect than between each successive pair of 'severity' classes.
Three groups of MD can be distinguished based on the associated degree of disability: 'mild', 'moderate to severe' and 'severe with psychotic features'. In the future, these groups can be used to describe the distribution of disability in the depressed population. The marked difference between 'mild' MD and no MD suggests that 'mild' cases should be considered relevant.
与重度抑郁症（MD）相关的残疾在不同患者群体中的分布信息对卫生政策和规划具有重要意义。我们在荷兰普通人群样本中研究了MD的严重程度和类型（单次发作或复发发作）与残疾之间的关联。
我们使用了荷兰精神健康调查与发病率研究（NEMESIS）第一波（1996年）的数据。根据DSM-III-R标准，借助复合国际诊断访谈诊断MD的“严重程度”和“类型”。采用SF-36评分、卧床天数和缺勤天数作为残疾指标。通过方差分析和回归分析研究这些变量的差异。
发现复发型MD与残疾的关联并不比单次发作型MD更强。较高的“严重程度”类别与更多的残疾相关。然而，“中度”和“重度”MD之间的残疾程度差异非常小。非抑郁个体与轻度抑郁个体之间的残疾差异比每连续两组“严重程度”类别之间的差异影响更大。
根据相关的残疾程度可区分出三组MD：“轻度”、“中度至重度”和“伴有精神病性特征的重度”。未来，这些组可用于描述抑郁症患者群体中的残疾分布情况。“轻度”MD与无MD之间的显著差异表明“轻度”病例应被视为具有相关性。
