Conradi Henk Jan, de Jonge Peter, Ormel Johan
Department of Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands.
J Affect Disord. 2008 Jan;105(1-3):267-71. doi: 10.1016/j.jad.2007.04.017. Epub 2007 Jun 14.
The objectives of this study are: (1) identification of predictors for the three-year course of recurrent depression in the rarely studied, but relevant sample of primary care patients, and (2) investigation whether different outcome indicators, time to recurrence, proportion depression-free time and mean severity of depressive symptoms during follow-up, are associated with different risk factors.
Depression course was established by assessing 110 patients three-monthly with the Composite International Diagnostic Interview and the BDI, during a three-year period. Eight (groups of) predictors, assessed at baseline, were examined: socio-demographics, parental depression, history and severity of depression, anxiety, coping potential, social dysfunctioning and physical functioning.
Time to recurrence was predicted by number of previous episodes (OR=1.91). Both proportion depressive disorder-free time and mean depression severity during follow-up were predicted by: severity of depression (B=-.19 and .21 respectively), anxiety (B=-.32 and .33), social dysfunctioning (B=-.21 and .22) and physical functioning (B=.24 and -.39). Mean severity was additionally predicted by: educational level (B=-.21), duration of the longest prior episode (B=.32), and coping potential (B=-.40). Coping potential and number of previous episodes were marginally significant predictors for all three outcomes.
Although substantial, sample size was restricted.
Different outcome variables are predicted by different risk factors. Restriction to one outcome may lead to missing important determinants of the depression course. Number of prior episodes and coping potential seem to warrant special attention from the GP.
本研究的目的是：（1）在研究较少但相关的初级保健患者样本中，确定复发性抑郁症三年病程的预测因素；（2）调查不同的结局指标，即复发时间、随访期间无抑郁时间比例和抑郁症状平均严重程度，是否与不同的风险因素相关。
在三年期间，每三个月通过综合国际诊断访谈和贝克抑郁量表对110名患者进行评估，以确定抑郁症病程。在基线时评估了八个（组）预测因素：社会人口统计学、父母抑郁、抑郁症病史和严重程度、焦虑、应对能力、社会功能障碍和身体功能。
复发时间由既往发作次数预测（OR=1.91）。随访期间无抑郁障碍时间比例和抑郁平均严重程度均由以下因素预测：抑郁症严重程度（分别为B=-0.19和0.21）、焦虑（B=-0.32和0.33）、社会功能障碍（B=-0.21和0.22）和身体功能（B=0.24和-0.39）。抑郁平均严重程度还由以下因素预测：教育水平（B=-0.21）、既往最长发作持续时间（B=0.32）和应对能力（B=-0.40）。应对能力和既往发作次数是所有三个结局的边缘显著预测因素。
尽管样本量很大，但仍受到限制。
不同的结局变量由不同的风险因素预测。仅关注一种结局可能会遗漏抑郁症病程的重要决定因素。既往发作次数和应对能力似乎值得全科医生特别关注。
