Parker G, Hall W, Boyce P, Hadzi-Pavlovic D, Mitchell P, Wilhelm K, Brodaty H, Hickie I, Eyers K
Mood Disorders Unit, Prince Henry Hospital, Sydney.
Aust N Z J Psychiatry. 1991 Mar;25(1):63-76. doi: 10.3109/00048679109077720.
The strongest statistical support for the binary view of depression has been provided by factor (principal components) analytic studies which delineate a bipolar factor with features interpreted as reflecting "endogenous depression" and "neurotic depression" at opposing poles. We review the seminal studies to suggest instead that the bipolar factor has generally polarised depression and anxiety, and that no such entity or symptom complex of "neurotic depression" has been isolated. Instead "neurotic depression" has been defined principally by features of anxiety and personality style. We argue that the suggested entity is, in fact, a pseudo-entity, being no more than a residual group of non-depressive features without any significant intrinsic depressive characteristics. We support our interpretation by showing comparable solutions in published studies of depressives alone, contrasted with separate analyses of anxious and depressed patients. We also report two studies in which the "neurotic depressive" pole is made to appear and disappear by the inclusion and exclusion of anxiety items. As factor analytic studies have defined the "residual" pole so variably, we argue that some features held to distinguish neurotic depression are of no utility and that such a diagnosis is meaningless. We suggest that the clinician should not proceed (after excluding endogenous depression) to conclude that the default option is necessarily an entity "neurotic depression" and that instead a heterogeneous group of options (e.g. anxiety, personality disorder) require review. If the "neurotic depressive" type of the multivariate analytic studies is a pseudo-entity, then a modified unitary view of depression may be valid.
对抑郁症二元观点最有力的统计支持来自因素（主成分）分析研究，这些研究描绘了一个两极因素，其特征被解释为在相对的两极反映“内源性抑郁症”和“神经症性抑郁症”。我们回顾了一些开创性研究，认为相反，这个两极因素通常使抑郁症和焦虑症两极分化，而且并没有分离出“神经症性抑郁症”这样的实体或症状复合体。相反，“神经症性抑郁症”主要是由焦虑和人格风格的特征来定义的。我们认为所提出的这个实体实际上是一个伪实体，只不过是一组非抑郁特征的残余组合，没有任何显著的内在抑郁特征。我们通过在已发表的仅关于抑郁症患者的研究中展示可比的结果来支持我们的解释，并与对焦虑症和抑郁症患者的单独分析进行对比。我们还报告了两项研究，其中通过纳入和排除焦虑项目使“神经症性抑郁”极出现和消失。由于因素分析研究对“残余”极的定义如此多变，我们认为一些被认为可区分神经症性抑郁症的特征并无用处，这样的诊断是没有意义的。我们建议临床医生在排除内源性抑郁症后，不应得出默认选项必然是“神经症性抑郁症”这一实体的结论，而应转而审视一组异质性的选项（如焦虑症、人格障碍）。如果多变量分析研究中的“神经症性抑郁”类型是一个伪实体，那么一种修正后的抑郁症单一观点可能是有效的。
