Klein Daniel N, Shankman Stewart A, Lewinsohn Peter M, Seeley John R
Dr. Klein is with State University of New York-Stony Brook; Dr. Shankman is with the University of Illinois; and Drs. Lewinsohn and Seeley are with the Oregon Research Institute.
Dr. Klein is with State University of New York-Stony Brook; Dr. Shankman is with the University of Illinois; and Drs. Lewinsohn and Seeley are with the Oregon Research Institute.
J Am Acad Child Adolesc Psychiatry. 2009 Jul;48(7):703-710. doi: 10.1097/CHI.0b013e3181a56606.
Subthreshold depressive disorder is one of the best established risk factors for the onset of full-syndrome depressive disorders. However, many youths with subthreshold depressive disorder do not develop full-syndrome depression. We examined predictors of escalation to full-syndrome depressive disorders in a community sample of 225 adolescents with subthreshold depressive disorder.
Criteria for subthreshold depressive disorder were an episode of depressed mood or loss of interest or pleasure lasting at least 1 week and at least two of the seven other DSM-IV-associated symptoms for major depression. Participants were assessed four times from mid-adolescence to age 30 years using semistructured diagnostic interviews.
The estimated risk for escalation to full-syndrome depressive disorders was 67%. Five variables accounted for unique variance in predicting escalation: severity of depressive symptoms, medical conditions/symptoms, history of suicidal ideation, history of anxiety disorder, and familial loading for depression. Adolescents with three or more risk factors had an estimated 90% chance of escalating to full-syndrome depressive disorder, compared with 47% of adolescents with fewer than three risk factors.
These data may be useful in identifying a subgroup of youths with subthreshold depressive disorder who are at especially high risk for escalating to full-syndrome depressive disorders.
阈下抑郁障碍是完全综合征抑郁障碍发病的最佳确定危险因素之一。然而，许多患有阈下抑郁障碍的青少年并未发展为完全综合征抑郁症。我们在一个由225名患有阈下抑郁障碍的青少年组成的社区样本中，研究了发展为完全综合征抑郁障碍的预测因素。
阈下抑郁障碍的标准是情绪低落或兴趣或愉悦感丧失的发作持续至少1周，且至少具备其他七种与DSM-IV相关的重度抑郁症状中的两种。参与者从青春期中期到30岁接受了四次半结构化诊断访谈评估。
发展为完全综合征抑郁障碍的估计风险为67%。五个变量在预测病情进展方面具有独特的方差：抑郁症状的严重程度、身体状况/症状、自杀意念史、焦虑障碍史以及抑郁症的家族负荷。有三个或更多危险因素的青少年发展为完全综合征抑郁障碍的估计几率为90%，而危险因素少于三个的青少年这一几率为47%。
这些数据可能有助于识别出患有阈下抑郁障碍且发展为完全综合征抑郁障碍风险特别高的青少年亚组。
