Center for Population and Development Studies, Harvard School of Public Health, Boston, MA, USA.
Ann Epidemiol. 2009 Nov;19(11):761-70. doi: 10.1016/j.annepidem.2009.06.005. Epub 2009 Aug 21.
To identify and understand the patterns and predictors of depressive symptom trajectories over time after mass traumatic events.
Data were used from a prospective, representative sample of adult residents of the New York City metropolitan area (N=2,282) followed up across four survey waves between 2001 (after the September 11 attacks) and 2004. Semi-parametric group-based modeling was used to identify trajectories, as well as the time-fixed and time-varying predictors of distinct depressive trajectories.
Five distinct trajectories of depression were characterized: minimal symptomatology at all time points (group 1, 39% of sample), mild delayed depression (group 2, 34% of sample), recovery (group 3, 6% of sample), severe delayed depression (group 4, 13% of sample), and chronic severe depression (group 5, 8% of sample). Among members of distinct trajectories, lower household income, exposure to ongoing stressors, and exposure to traumatic events were commonly associated with an increased number of depressive symptoms.
Ongoing socioeconomic adversity appears to be centrally associated with a worse course of depression after exposure to traumatic events. Identifying distinct trajectories of depression and the preventable factors that are associated with them may facilitate the development of interventions that aim to promote better mental health.
识别和理解大规模创伤性事件后随时间推移的抑郁症状轨迹的模式和预测因素。
使用了一项针对纽约市大都市区成年居民的前瞻性、代表性样本的数据（N=2282），在 2001 年（9·11 袭击后）至 2004 年期间进行了四次调查。使用半参数基于群组的建模来识别轨迹，以及不同抑郁轨迹的时间固定和时变预测因素。
描述了五种不同的抑郁轨迹：所有时间点的症状都轻微（第 1 组，占样本的 39%）、轻度延迟性抑郁（第 2 组，占样本的 34%）、恢复（第 3 组，占样本的 6%）、严重延迟性抑郁（第 4 组，占样本的 13%）和慢性重度抑郁（第 5 组，占样本的 8%）。在不同轨迹的成员中，较低的家庭收入、持续存在的压力源暴露和创伤性事件暴露通常与更多的抑郁症状有关。
持续的社会经济劣势似乎与创伤后抑郁的恶化过程密切相关。确定不同的抑郁轨迹以及与之相关的可预防因素可能有助于开发旨在促进更好心理健康的干预措施。
