Kendler Kenneth S, Kuhn Jonathan, Prescott Carol A
Virginia Institute for Psychiatry and Behavioral Genetics and Department of Psychiatry, Medical College of Virginia, Virginia Commonwealth University, Richmond, 23298-0126, USA.
Am J Psychiatry. 2004 Apr;161(4):631-6. doi: 10.1176/appi.ajp.161.4.631.
Three potent risk factors for major depression are female sex, the personality trait of neuroticism, and adversity resulting from exposure to stressful life events. Little is known about how they interrelate in the etiology of depressive illness.
In over 7,500 individual twins from a population-based sample, the authors used a Cox proportional hazard model to predict onsets of episodes of DSM-III-R major depression in the year before the latest interviews on the basis of previously assessed neuroticism, sex, and adversity during the past year; adversity was operationalized as the long-term contextual threat scored from 15 life event categories.
In the best-fit Cox model for prediction of depressive onsets, neuroticism, female sex, and greater adversity all strongly increased risk for major depression. An interaction was seen between neuroticism and adversity such that individuals with high neuroticism were at greater overall risk for major depression and were more sensitive to the depressogenic effects of adversity. An interaction was also seen between adversity and sex, as the excess risk for major depression in women was confined to individuals with low stress exposure.
Psychosocial adversity interacts both with neuroticism and with sex in the etiology of major depression. The impact of neuroticism on illness risk is greater at high than at low levels of adversity, while the effect of sex on probability of onset is the opposite--greater at low than at high levels of stress. Complete etiologic models for major depression should incorporate interactions between risk factor classes.
重度抑郁症的三个主要风险因素为女性性别、神经质人格特质以及因暴露于应激性生活事件而产生的逆境。关于它们在抑郁症病因学中如何相互关联，目前所知甚少。
在一个基于人群样本的7500多名双胞胎个体中，作者使用Cox比例风险模型，根据先前评估的神经质、性别以及过去一年中的逆境情况，预测在最近一次访谈前一年中DSM-III-R重度抑郁症发作情况；逆境被定义为从15类生活事件中得出的长期背景威胁得分。
在预测抑郁症发作的最佳拟合Cox模型中，神经质、女性性别以及更大的逆境都显著增加了患重度抑郁症的风险。神经质与逆境之间存在交互作用，即高神经质个体患重度抑郁症的总体风险更高，且对逆境的致抑郁作用更敏感。逆境与性别之间也存在交互作用，因为女性患重度抑郁症的额外风险仅限于低应激暴露个体。
在重度抑郁症的病因学中，心理社会逆境与神经质和性别均存在相互作用。在高逆境水平下，神经质对患病风险的影响大于低逆境水平时，而性别对发病概率的影响则相反——在低应激水平下大于高应激水平时。完整的重度抑郁症病因模型应纳入风险因素类别之间的相互作用。
