Warner V, Wickramaratne P, Weissman M M
Division of Epidemiology, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
Psychol Med. 2008 Nov;38(11):1543-56. doi: 10.1017/S0033291708002894. Epub 2008 Feb 14.
The overlap between anxiety and major depressive disorder (MDD), the increased risk for depression and anxiety in offspring of depressed parents, the sequence of onset with anxiety preceding MDD, and anxiety as a predictor of depression are well established. The specificity of anxiety disorders in these relationships is unclear. This study, using a longitudinal high-risk design, examined whether anxiety disorders associated with the emotions fear and anxiety mediate the association between parental and offspring depression.
Two hundred and twenty-four second-generation and 155 third-generation descendants at high and low risk for depression because of MDD in the first generation were interviewed over 20 years. Probit and Cox proportional hazard models were fitted with generation 2 (G2) or G3 depression as the outcome and parental MDD as the predictor. In G2 and G3, fear- (phobia or panic) and anxiety-related [overanxious or generalized anxiety disorder (GAD)] disorders were examined as potential mediators of increased risk for offspring depression, due to parental MDD.
In G2, fear-related disorders met criteria for mediating the association between parental MDD and offspring MDD whereas anxiety-related disorders did not. These results were consistent, regardless of the analytic methods used. Further investigation of the mediating effect of fear-related disorders by age of onset of offspring MDD suggests that the mediating effect occurs primarily in adolescent onset MDD. The results for G3 appear to follow similar patterns.
These findings support the separation of anxiety disorders into at least two distinct forms, particularly when examining their role in the etiology of depression.
焦虑症与重度抑郁症（MDD）之间的重叠、抑郁症患者后代患抑郁症和焦虑症的风险增加、MDD发病前焦虑症的发病顺序以及焦虑症作为抑郁症的预测指标已得到充分证实。这些关系中焦虑症的特异性尚不清楚。本研究采用纵向高危设计，检验了与恐惧和焦虑情绪相关的焦虑症是否介导了父母与后代抑郁症之间的关联。
对第一代因MDD而处于高、低抑郁风险的224名第二代和155名第三代后代进行了为期20年的访谈。以第二代（G2）或第三代（G3）抑郁症为结局变量，以父母MDD为预测变量，拟合概率单位和Cox比例风险模型。在G2和G3中，检查恐惧相关（恐惧症或惊恐症）和焦虑相关（过度焦虑或广泛性焦虑症（GAD））障碍是否为父母MDD导致后代抑郁症风险增加的潜在中介因素。
在G2中，恐惧相关障碍符合介导父母MDD与后代MDD之间关联的标准，而焦虑相关障碍则不符合。无论使用何种分析方法，这些结果都是一致的。通过后代MDD发病年龄对恐惧相关障碍的中介作用进行进一步研究表明，中介作用主要发生在青少年期发病的MDD中。G3的结果似乎遵循类似的模式。
这些发现支持将焦虑症至少分为两种不同的形式，特别是在研究它们在抑郁症病因学中的作用时。
