Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, PO Box 913, Dunedin, New Zealand.
Compr Psychiatry. 2011 Nov-Dec;52(6):623-9. doi: 10.1016/j.comppsych.2010.12.006. Epub 2011 Mar 2.
The age at which a depressive episode is first experienced may be associated with particular individual and clinical characteristics. This study compares individual, clinical, and family characteristics across individuals who experienced their first major depressive episode when a child, teenager, or adult.
Participants were 372 depressed outpatients who participated in 2 completed randomized trials for depression. The first compared fluoxetine and nortriptyline, whereas the second compared cognitive behavior therapy and interpersonal psychotherapy. Assessment across the studies included structured clinical interviews for Diagnostic and Statistical Manual of Mental Disorders (DSM) Axis I/II diagnoses and a range of self-report measures of symptoms, functioning, and childhood experiences.
Participants with childhood- and teenage-onset depression had a greater number of comorbid Axis I diagnoses, were more likely to meet criteria for Avoidant and Paranoid personality disorder (PD), and were more likely to have attempted suicide than those with adult-onset depression. Those with teenage-onset depression were more likely to meet criteria for a PD than those with adult-onset depression. Participants with childhood- and teenage-onset depression reported lower perceptions of paternal care before the age of 16 years, compared to participants with adult-onset depression.
Retrospective recall was used to classify individuals into childhood-, teenage-, and adult-onset groups and is subject to recall biases. The sample also consisted of treatment-seeking individuals.
There were relatively few differences between teenage and childhood depression. Depressive episodes that begin in childhood or teenage years are associated with more comorbid diagnoses, a higher likelihood of Avoidant and Paranoid PD, a greater likelihood of attempted suicide, and poorer perceptions of paternal care. Compared to adult-onset depression, childhood-onset depression is associated with greater comorbidity.
首次经历抑郁发作的年龄可能与个体和临床特征有关。本研究比较了在儿童、青少年或成年期首次发生重度抑郁症的个体的个体、临床和家庭特征。
372 名抑郁门诊患者参与了 2 项针对抑郁症的完整随机试验。第一项比较氟西汀和去甲替林，第二项比较认知行为疗法和人际关系心理治疗。在这两项研究中，评估包括用于诊断和统计手册（DSM）轴 I/II 诊断的结构化临床访谈以及一系列症状、功能和儿童期经历的自我报告量表。
儿童期和青少年期发病的抑郁症患者有更多的共病轴 I 诊断，更有可能符合回避型和偏执型人格障碍（PD）的标准，并且更有可能自杀未遂，而成年期发病的抑郁症患者则较少。与成年期发病的抑郁症患者相比，青少年期发病的抑郁症患者更有可能符合 PD 的标准。与成年期发病的抑郁症患者相比，儿童期和青少年期发病的抑郁症患者在 16 岁之前对父亲照顾的评价较低。
使用回顾性回忆将个体分类为儿童期、青少年期和成年期发病组，易受回忆偏差的影响。该样本还包括接受治疗的个体。
青少年和儿童抑郁症之间相对较少的差异。儿童期或青少年期开始的抑郁发作与更多的共病诊断、更高的回避型和偏执型 PD 可能性、更大的自杀企图可能性以及较差的父亲照顾感有关。与成年期发病的抑郁症相比，儿童期发病的抑郁症与更高的共病有关。
