Institute of Neuroscience, Department of Psychiatry, Trinity College Dublin, Dublin 2, Ireland.
J Psychiatr Res. 2010 Oct;44(13):799-807. doi: 10.1016/j.jpsychires.2010.01.006. Epub 2010 Feb 1.
Early emotional stress is associated with a life-long burden of risk for later depression and stressful life events contribute to the development of depressive episodes. In this study we investigated whether childhood stress is associated with structural brain alterations in patients with major depression (MD). Forty-three patients with MD and 44 age as well as gender matched healthy control subjects were investigated using high-resolution magnetic resonance imaging (MRI). Region of interest analysis of the hippocampus, whole brain voxel-based morphometry (VBM) and assessment of childhood stress was carried out. Significantly smaller hippocampal white matter and prefrontal gray matter volume was observed in patients with MD compared to healthy controls. In particular left hippocampal white matter was smaller in patients, who had emotional childhood neglect, compared to those without neglect. For male patients this effect was seen in the left and right hippocampus. Moreover, physical neglect during childhood affected prefrontal gray matter volume in healthy subjects. Both emotional neglect and brain structural abnormalities predicted cumulative illness duration and there was a significant interaction between emotional neglect and prefrontal volumes as well as hippocampal white matter on the illness course. Childhood neglect resulted in hippocampal white matter changes in patients with major depression, pronounced at the left side and in males. Most interestingly, childhood stress and brain structure volumes independently predicted cumulative illness course. Subjects with both, structural brain changes and childhood emotional neglect seem to be at a very high risk to develop a more severe illness course.
早期的情绪压力与以后抑郁的终身风险负担有关，生活应激事件也促成了抑郁发作的发生。在这项研究中，我们调查了童年期应激是否与重度抑郁症（MD）患者的大脑结构改变有关。使用高分辨率磁共振成像（MRI）对 43 名 MD 患者和 44 名年龄和性别匹配的健康对照者进行了研究。对海马体进行了感兴趣区分析、全脑基于体素的形态计量学（VBM）以及对童年期应激的评估。与健康对照组相比，MD 患者的海马体白质和前额叶灰质体积明显较小。特别是在有情感忽视的 MD 患者中，左侧海马体白质体积更小，而没有忽视的患者则没有这种现象。对于男性患者，这种效应出现在左侧和右侧海马体中。此外，儿童期躯体忽视会影响健康受试者的前额叶灰质体积。情感忽视和脑结构异常均预测累积发病时间，情感忽视与前额叶体积以及海马体白质之间存在显著的相互作用，影响疾病进程。童年期情感忽视导致重度抑郁症患者的海马体白质改变，左侧和男性患者尤为明显。最有趣的是，童年期应激和大脑结构体积可独立预测累积发病时间。有结构脑改变和童年期情感忽视的患者似乎有极高的风险发展为更严重的疾病进程。
