Blazer Dan G, Hybels Celia F
Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, Durham, NC 24410, USA.
Psychol Med. 2005 Sep;35(9):1241-52. doi: 10.1017/S0033291705004411.
Despite the burden of depression in late life, its origins present a paradox to investigators and clinicians alike.
We review biological (genetics and heredity factors, neurotransmitter dysfunction, endocrine changes, vascular disorders, and medical co-morbidities), psychological (personality attributes, neuroticism, cognitive distortions, and the lack of emotional control and self-efficacy) and social (stressful life events, bereavement, chronic stress or strain, socio-economic disadvantage and impaired social support) origins of late-life depression based upon an extensive though not exhaustive review of the extant literature. In addition, modifying psychological and social factors are discussed.
Older adults appear to be at greater risk for major depression biologically, such as depression resulting from vascular changes, yet the frequency of depression is lower compared to younger adults. Older adults may be protected psychologically due to factors such as socio-emotional selectivity and wisdom, compared to younger adults, and perhaps relatively protected from social risks.
A biopsychosocial approach to evaluating the origins of late-life depression is heuristically valuable, a continual reminder of the many factors that contribute to the onset and persistence of clinically significant symptoms in late life.
尽管晚年抑郁症负担沉重，但其病因却给研究人员和临床医生都带来了一个悖论。
我们基于对现有文献的广泛（虽不详尽）回顾，审视晚年抑郁症的生物学（基因和遗传因素、神经递质功能障碍、内分泌变化、血管疾病和共病）、心理学（人格特质、神经质、认知扭曲以及缺乏情绪控制和自我效能感）和社会（生活应激事件、丧亲之痛、慢性压力或紧张、社会经济劣势和社会支持受损）病因。此外，还讨论了调节心理和社会因素。
老年人在生物学上似乎患重度抑郁症的风险更高，比如因血管变化导致的抑郁症，但与年轻人相比，抑郁症的发病率较低。与年轻人相比，老年人可能因社会情感选择性和智慧等因素在心理上受到保护，并且或许相对免受社会风险影响。
采用生物心理社会方法来评估晚年抑郁症的病因具有启发价值，它不断提醒人们有许多因素导致晚年出现具有临床意义的症状并持续存在。
