Black Donald W, Carney Caroline P, Forman-Hoffman Valerie L, Letuchy Elena, Peloso Paul, Woolson Robert F, Doebbeling Bradley N
Department of Psychiatry, University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa 52242, USA.
Ann Clin Psychiatry. 2004 Apr-Jun;16(2):53-61. doi: 10.1080/10401230490452645.
Depression is a common mental disorder associated with poor health outcomes. The purpose of this study is to examine the prevalence of depression, mental health comorbidity, illness variables, and quality of life in a sample of military veterans serving during the first Gulf War. The Iowa Gulf War Case Validation Study involved face-to-face evaluations in 1999--2002 of 602 military personnel--either deployed ("deployed veterans") or eligible but not deployed ("non-deployed veterans") to the Gulf. Subjects were sampled by conducting a series of case-control studies nested within a population-based survey of 4,886 military personnel. All subjects were interviewed using the Structured Clinical Interview for DSM-IV (SCID-IV), and a series of semi-structured interviews and validated questionnaires. Best estimate psychiatric diagnoses were assigned based on all available data. One-hundred-ninety-two (32%) of the 602 surveyed veterans met criteria for a current or lifetime depressive disorder (major depression, dysthymia, depressive disorder--not otherwise specified). Depressed non-deployed veterans were more likely to be female and to have served in the Air Force than depressed deployed veterans. There were few significant differences between the depressed deployed veterans and the depressed non-deployed veterans. Depressed deployed veterans had significantly higher lifetime rates of comorbid cognitive dysfunction (55% vs. 35%), and anxiety disorders (59% vs. 33%)--mainly accounted for by specific phobias (12% vs. 2%) and posttraumatic stress disorder (33% vs. 10%)--than did depressed non-deployed veterans. Lifetime substance use disorders were significantly more frequent in deployed veterans than non-deployed veterans (70% vs. 52%), particularly alcohol disorders (68% vs. 52%). There were no differences in rates of personality characteristics, family psychiatric history, stressors, hypochondriasis, and level of functioning between the two study groups showed no significant differences. Depressive illness is frequent in military samples, as it is in the general population. The prevalence, pattern of comorbidity, and illness features were similar in deployed veterans and non-deployed veterans, suggesting that the depression suffered by both groups of veterans is qualitatively comparable. The main difference between study, groups was that depressed deployed veterans had higher rates than depressed non-deployed veterans of comorbid anxiety disorders, hypothesized to be part of the stress-related syndromes seen in those who experience combat.
抑郁症是一种常见的精神障碍，与不良健康后果相关。本研究的目的是调查参加过第一次海湾战争的退伍军人样本中抑郁症的患病率、心理健康合并症、疾病变量和生活质量。爱荷华海湾战争病例验证研究在1999年至2002年期间对602名军事人员进行了面对面评估，这些人员要么被部署到海湾地区（“部署退伍军人”），要么符合条件但未被部署（“未部署退伍军人”）。通过在对4886名军事人员进行的基于人群的调查中开展一系列病例对照研究来抽取研究对象。所有研究对象均使用《精神疾病诊断与统计手册》第四版结构化临床访谈（SCID-IV）以及一系列半结构化访谈和经过验证的问卷进行访谈。根据所有可用数据进行最佳估计的精神科诊断。在602名接受调查的退伍军人中，有192人（32%）符合当前或终生抑郁症（重度抑郁症、恶劣心境、未另行说明的抑郁症）的标准。与患有抑郁症的部署退伍军人相比，患有抑郁症的未部署退伍军人更可能为女性且曾在空军服役。患有抑郁症的部署退伍军人与患有抑郁症的未部署退伍军人之间几乎没有显著差异。患有抑郁症的部署退伍军人共病认知功能障碍（55%对35%）和焦虑症（59%对33%）的终生患病率显著更高，焦虑症主要由特定恐惧症（12%对2%）和创伤后应激障碍（33%对10%）构成，而患有抑郁症的未部署退伍军人则不然。部署退伍军人终生物质使用障碍的发生率显著高于未部署退伍军人（70%对52%），尤其是酒精障碍（68%对52%）。两个研究组在人格特征、家族精神病史、应激源、疑病症和功能水平方面的发生率没有差异。抑郁症在军人样本中很常见，在普通人群中也是如此。部署退伍军人和未部署退伍军人的患病率、合并症模式和疾病特征相似，这表明两组退伍军人所患抑郁症在性质上具有可比性。研究组之间的主要差异在于，患有抑郁症的部署退伍军人共病焦虑症的发生率高于患有抑郁症的未部署退伍军人，推测这是经历战斗者所见应激相关综合征的一部分。
