双相情感障碍患者子女在14个月随访期间的应激性生活事件与情绪障碍的发病情况
Stressful life events and onset of mood disorders in children of bipolar parents during 14-month follow-up.
作者信息
Wals Marjolein, Hillegers Manon H J, Reichart Catrien G, Verhulst Frank C, Nolen Willem A, Ormel Johan
机构信息
Erasmus Medical Center Rotterdam/Department of Child and Adolescent Psychiatry, Sophia Children's Hospital, Rotterdam, The Netherlands.
出版信息
J Affect Disord. 2005 Aug;87(2-3):253-63. doi: 10.1016/j.jad.2005.04.006.
BACKGROUND
Although multiple studies have examined the association between stressful life events (SLEs) and the development of mood disorders, the exact nature of the association and the degree to which it is independent from familial loading (FL) and gender-specific are still not fully elucidated.
AIMS
To study the association between person-independent and -dependent SLEs and first onset or recurrence of a DSM-IV mood disorder episode (MDE) in offspring of bipolar parents. To examine interaction effects of SLEs with familial loading and gender.
METHOD
Offspring of bipolar parents (N=132) were assessed with the K-LEDS, the FHRDC and the K-SADS. Logistic regression analysis was used to examine main and interaction effects of various operationalizations of SLEs, familial loading and gender.
RESULTS
Dependent SLEs were more likely to occur before onset among the 13 offspring who had a MDE onset during the 14-month follow-up (39%) than in a comparable period among the 67 controls without any lifetime diagnosis (10%). Associations were slightly stronger for first onsets than for recurrences. The association between SLEs and MDE onset/recurrence was independent of socio-demographic characteristics and familial loading, but disappeared when adjusted for baseline anxious/depressive symptoms. Gender and familial loading did not modify the influence of any SLE measure on the development of mood disorders.
CONCLUSIONS
In this sample of bipolar offspring dependent stressful SLEs triggered the onset of MDEs, but this association disappeared after adjustment of prior anxious/depressive symptoms, indicating that the association between SLEs and MDE is probably a spurious association. No interaction was found between SLE and FL and gender. Prior anxious/depressive symptoms seem to increase the risk for both occurrence of dependent SLEs and MDE onset or recurrence.
LIMITATIONS
Limited statistical power due to small number of MDE onsets.
背景
尽管多项研究探讨了应激性生活事件（SLEs）与情绪障碍发生之间的关联，但这种关联的确切性质以及其独立于家族负荷（FL）和性别特异性的程度仍未完全阐明。
目的
研究双相情感障碍患者后代中与个体无关和相关的SLEs与DSM-IV情绪障碍发作（MDE）首次发作或复发之间的关联。探讨SLEs与家族负荷和性别的交互作用。
方法
使用K-LEDS、FHRDC和K-SADS对双相情感障碍患者的132名后代进行评估。采用逻辑回归分析来检验SLEs、家族负荷和性别的各种操作化指标的主效应和交互效应。
结果
在14个月随访期间出现MDE发作的13名后代中，相关的SLEs在发作前出现的可能性（39%）高于67名无任何终生诊断的对照组在可比时期内出现的可能性（10%）。首次发作的关联略强于复发。SLEs与MDE发作/复发之间的关联独立于社会人口学特征和家族负荷，但在调整基线焦虑/抑郁症状后消失。性别和家族负荷并未改变任何SLE测量指标对情绪障碍发展的影响。
结论
在这个双相情感障碍后代样本中，相关的应激性SLEs引发了MDEs的发作，但在调整先前的焦虑/抑郁症状后这种关联消失，表明SLEs与MDE之间的关联可能是一种虚假关联。未发现SLE与FL及性别之间存在交互作用。先前的焦虑/抑郁症状似乎增加了相关SLEs发生以及MDE发作或复发的风险。
局限性
由于MDE发作数量少，统计效力有限。
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