Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75390-9101, USA.
J Am Acad Child Adolesc Psychiatry. 2010 Feb;49(2):141-51. doi: 10.1097/00004583-201002000-00008.
The study examined whether cortisol measures are associated with the clinical course of depression in adolescents. Furthermore, the study evaluated whether the relationship between cortisol and clinical course is moderated by environmental stress and/or social support.
Fifty-five adolescents with depression (age range 13-18 years) were recruited. In addition to a systematic diagnostic assessment, information was obtained on environmental stress and social support. Urinary free cortisol measures were collected on three consecutive nights during the index episode. Clinical follow-up evaluations were conducted at regular intervals over a 5-year period, documenting recovery from the index depressive episode and recurrent episodes. Information on environmental stress and social support also was gathered during each follow-up assessment.
Consistent with prior reports, the majority of adolescents (92.2%) recovered from the initial depressive episode. A substantial proportion of the recovered youth (42.6%) experienced a subsequent episode during the follow-up period. Higher cortisol levels were associated with a longer time to recovery from the index depressive episode. The effect of cortisol on recovery was moderated by social support. The combination of elevated cortisol and recent stressful experiences predicted recurrence, whereas a higher level of social support was protective against recurrence.
These data, in conjunction with prior literature, suggest that depression reflects an underlying neurobiological vulnerability that may predispose individuals with high vulnerability to chronic, recurrent episodes. Psychosocial factors, independently or in combination with an underlying neurobiological vulnerability, also play an important role in determining the clinical course of depression.
本研究旨在探讨皮质醇水平是否与青少年抑郁症的临床病程相关。此外，本研究还评估了皮质醇与临床病程之间的关系是否受到环境压力和/或社会支持的调节。
招募了 55 名患有抑郁症的青少年（年龄范围为 13-18 岁）。除了进行系统的诊断评估外，还收集了有关环境压力和社会支持的信息。在指数发作期间连续三个晚上收集尿液游离皮质醇测量值。在 5 年的时间内定期进行临床随访评估，记录从指数抑郁发作和复发性发作中恢复的情况。在每次随访评估中还收集了有关环境压力和社会支持的信息。
与先前的报告一致，大多数青少年（92.2%）从最初的抑郁发作中恢复。相当一部分康复的青少年（42.6%）在随访期间经历了随后的发作。较高的皮质醇水平与从指数抑郁发作中恢复的时间较长相关。皮质醇对恢复的影响受社会支持的调节。皮质醇升高和近期压力体验的组合预测了复发，而较高的社会支持水平则可以预防复发。
这些数据与先前的文献一起表明，抑郁症反映了一种潜在的神经生物学脆弱性，这种脆弱性可能使高脆弱性的个体容易发生慢性、复发性发作。心理社会因素，独立或与潜在的神经生物学脆弱性相结合，在决定抑郁症的临床病程方面也起着重要作用。
