Bromberger J T, Kravitz H M, Matthews K, Youk A, Brown C, Feng W
Departments of Epidemiology and Psychiatry, and Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
Psychol Med. 2009 Jan;39(1):55-64. doi: 10.1017/S0033291708003218. Epub 2008 Apr 1.
Little is known about factors that predict first lifetime episodes of major depression in middle-aged women. It is not known whether health-related factors and life stress pose more or less of a risk to the onset of clinical depression than does the menopausal transition.
The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID) was used to assess diagnoses of lifetime, annual and current major depression in a community-based sample of premenopausal or early perimenopausal African American and White women. Menstrual cycle characteristics, psychosocial and health-related factors, and blood samples for assay of reproductive hormones were obtained annually. Two hundred and sixty-six women without a history of major depression at baseline constituted the cohort for the current analyses.
Over 7 years of follow-up, 42 (15.8%) women met criteria for a diagnosis of major depression. Frequent vasomotor symptoms (VMS; hot flashes and/or night sweats) (HR 2.14, p=0.03) were a significant predictor of major depression in univariate analyses. After simultaneous adjustment for multiple predictors in Cox proportional hazards analyses, frequent VMS were no longer significant; lifetime history of an anxiety disorder (HR 2.20, p=0.02) and role limitations due to physical health (HR 1.88, p=0.07) at baseline and a very stressful life event (HR 2.25, p=0.04) prior to depression onset predicted a first episode of major depression.
Both earlier (e.g. history of anxiety disorders) and more proximal factors (e.g. life stress) may be more important than VMS in contributing to a first episode of major depression during midlife.
关于预测中年女性首次出现重度抑郁症发作的因素，我们了解甚少。与健康相关的因素和生活压力对临床抑郁症发作的风险是否比绝经过渡更大或更小尚不清楚。
使用《精神疾病诊断与统计手册第四版》轴I障碍的结构化临床访谈（SCID）来评估以社区为基础的绝经前或围绝经期早期非裔美国人和白人女性样本中终生、年度和当前重度抑郁症的诊断。每年获取月经周期特征、心理社会和与健康相关的因素以及用于检测生殖激素的血样。266名基线时无重度抑郁症病史的女性构成了当前分析的队列。
在7年的随访中，42名（15.8%）女性符合重度抑郁症的诊断标准。在单因素分析中，频繁的血管舒缩症状（VMS；潮热和/或盗汗）（HR 2.14，p = 0.03）是重度抑郁症的重要预测因素。在Cox比例风险分析中同时对多个预测因素进行调整后，频繁的VMS不再具有显著性；基线时焦虑症的终生病史（HR 2.20，p = 0.02）、由于身体健康导致的角色限制（HR 1.88，p = 0.07）以及抑郁症发作前的非常紧张的生活事件（HR 2.25，p = 0.04）预测了重度抑郁症的首次发作。
在导致中年首次出现重度抑郁症发作方面，早期因素（如焦虑症病史）和更直接的因素（如生活压力）可能比VMS更重要。
