Reynolds C F, Hoch C C, Buysse D J, Houck P R, Schlernitzauer M, Frank E, Mazumdar S, Kupfer D J
Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, PA 15213.
Biol Psychiatry. 1992 Jan 1;31(1):69-82. doi: 10.1016/0006-3223(92)90007-m.
Although spousal bereavement in late life is common and frequently leads to major depression, the boundary between bereavement without a depressive syndrome and bereavement-related depression has been insufficiently studied from a physiological perspective. Because other forms of depression are associated with physiological changes, including sleep, we have attempted to clarify the relationship of bereavement and bereavement-related depression by investigating electroencephalographic (EEG) sleep in 31 elderly volunteers with recent spousal bereavement, stratified by the presence (n = 15) or the absence (n = 16) of major depression (Research Diagnostic Criteria). Entry into the study was limited to volunteers without a personal history of psychiatric disorder. As hypothesized, bereaved subjects with major depression had significantly lower sleep efficiency, more early morning awakening, shorter rapid eye movement (REM) latency, greater REM sleep percent, and lower rates of delta wave generation in the first nonREM (NREM) period, compared with bereaved subjects without depression. Furthermore, the sleep of bereaved subjects with single-episode major depression resembled that of elderly patients with recurrent unipolar major depression (n = 15) on measures noted above. Sleep in bereavement without depression was similar to that of 15 healthy control subjects (neither bereaved nor depressed). These findings suggest that the current DSM-III-R concept of uncomplicated bereavement is not confirmed, as the sleep patterns of subjects who develop a depressive syndrome in the context of bereavement, many of whom might be considered to have "uncomplicated bereavement" by DSM-III-R standards, are identical to sleep patterns found in major depressive episodes. To our knowledge, this is the first study of EEG sleep in spousal bereavement with and without major depression.
尽管晚年丧配偶的情况很常见，且常常导致重度抑郁症，但从生理学角度来看，无抑郁综合征的丧亲之痛与丧亲相关抑郁症之间的界限尚未得到充分研究。由于其他形式的抑郁症与包括睡眠在内的生理变化有关，我们试图通过调查31名近期丧配偶的老年志愿者的脑电图（EEG）睡眠情况来阐明丧亲之痛与丧亲相关抑郁症之间的关系，这些志愿者根据是否存在重度抑郁症（研究诊断标准）分为两组，一组有抑郁症（n = 15），另一组无抑郁症（n = 16）。该研究的受试者仅限于无精神疾病个人史的志愿者。正如所假设的那样，与无抑郁症的丧亲受试者相比，患有重度抑郁症的丧亲受试者睡眠效率显著降低，清晨觉醒更多，快速眼动（REM）潜伏期更短，REM睡眠百分比更高，且在第一个非快速眼动（NREM）期的δ波发生率更低。此外，在上述测量指标上，单次发作重度抑郁症的丧亲受试者的睡眠情况与复发性单相重度抑郁症老年患者（n = 15）相似。无抑郁症的丧亲受试者的睡眠情况与15名健康对照受试者（既未丧亲也未患抑郁症）相似。这些发现表明，目前《精神疾病诊断与统计手册》第三版修订本（DSM-III-R）中关于单纯性丧亲之痛的概念未得到证实，因为在丧亲背景下出现抑郁综合征的受试者的睡眠模式，其中许多人按照DSM-III-R标准可能被认为患有“单纯性丧亲之痛”，与重度抑郁发作中的睡眠模式相同。据我们所知，这是第一项对有或无重度抑郁症的配偶丧亲之痛患者进行EEG睡眠研究。
