Sher Leo, Stanley Barbara H, Harkavy-Friedman Jill M, Carballo Juan J, Arendt Mikkel, Brent David A, Sperling Dahlia, Lizardi Dana, Mann J John, Oquendo Maria A
Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York, NY 10032, USA.
J Clin Psychiatry. 2008 Jun;69(6):907-15. doi: 10.4088/jcp.v69n0604.
Alcohol use and depressive disorders are frequently comorbid. Few studies have assessed the impact of comorbid alcohol use disorders (AUDs) on clinical aspects of major depression. We compared depressed subjects with and without co-occurring AUDs with respect to demographic and clinical parameters.
505 individuals participated. 318 subjects had DSM-IV major depressive disorder (MDD) without a history of any alcohol or substance abuse/dependence (MDD only), and 187 individuals had MDD and a history of alcohol abuse/dependence (MDD/AUD). Demographic, clinical, and psychiatric history measures of patients in the 2 groups were examined and compared. The study was conducted from January 1990 to June 2005.
MDD/AUD patients were younger at their first psychiatric hospitalization (p = .014), their first major depressive episode (p = .041), and their first suicide attempt (p = .001). They reported more previous major depressive episodes (p = .001), suicide attempts (p = .001), and recent life events (p = .001); and had higher lifetime aggression (p < .001), impulsivity (p < .001), and hostility (p < .001) scores. MDD/AUD patients were also more likely to report tobacco smoking (p < .001), a lifetime history of abuse (p = .004), and a history of AUD among first-degree relatives (p < .001) compared to MDD only patients. MDD/AUD individuals also had higher childhood (p < .001), adolescent (p < .001), and adult (p < .001) aggression scores and reported more behavioral problems during their childhood compared to their counterparts. Logistic regression analysis demonstrates that the number of previous depressive episodes, lifetime aggression, and smoking drive the difference between the groups.
Our findings suggest that comorbid MDD/AUD may result from worse antecedents and lead to early onset, more comorbidity, and a more severe course of illness.
酒精使用与抑郁障碍常合并存在。很少有研究评估合并酒精使用障碍（AUDs）对重度抑郁症临床特征的影响。我们比较了伴有和不伴有共病AUDs的抑郁症患者在人口统计学和临床参数方面的情况。
505人参与了研究。318名受试者患有DSM-IV重度抑郁症（MDD）且无任何酒精或物质滥用/依赖史（仅MDD），187名个体患有MDD且有酒精滥用/依赖史（MDD/AUD）。对两组患者的人口统计学、临床和精神病史指标进行了检查和比较。该研究于1990年1月至2005年6月进行。
MDD/AUD患者首次精神科住院（p = 0.014）、首次重度抑郁发作（p = 0.041）和首次自杀未遂（p = 0.001）时年龄更小。他们报告有更多既往重度抑郁发作（p = 0.001）、自杀未遂（p = 0.001）和近期生活事件（p = 0.001）；并且有更高的终生攻击性（p < 0.001）、冲动性（p < 0.001）和敌意（p < 0.001）得分。与仅患有MDD的患者相比，MDD/AUD患者也更有可能报告吸烟（p < 0.001）、有终生虐待史（p = 0.004）以及一级亲属中有AUD史（p < 0.001）。与仅患有MDD的患者相比，MDD/AUD个体在儿童期（p < 0.001）、青少年期（p < 0.001）和成年期（p < 0.001）的攻击性得分也更高，并且报告在儿童期有更多行为问题。逻辑回归分析表明，既往抑郁发作次数、终生攻击性和吸烟是两组之间差异的驱动因素。
我们的研究结果表明，合并MDD/AUD可能源于更差的发病前状况，并导致疾病早发、更多共病以及更严重的病程。
