Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center and GGZ inGeest, Amsterdam.
J Clin Psychiatry. 2011 Mar;72(3):288-94. doi: 10.4088/JCP.09m05735blu.
Few studies have investigated the importance of psychological characteristics for chronicity of depression. Knowledge about psychological differences between chronically depressed persons and nonchronically depressed persons may help to improve treatment of chronic depression. This is the first study to simultaneously compare in large samples various psychological characteristics between chronically depressed and nonchronically depressed adults.
Baseline data were drawn from the Netherlands Study of Depression and Anxiety (NESDA), an ongoing longitudinal cohort study aimed at examining the long-term course of depressive and anxiety disorders in different health care settings and phases of illness. Participants were aged 18 to 65 years at the baseline assessment in 2004-2007 and had a current diagnosis of DSM-IV major depressive disorder (N = 1,002). Chronicity of depression was defined as being depressed for 24 months or more in the past 4 to 5 years. The chronicity criterion was fulfilled by 31% (n = 312). The NEO Five-Factor Inventory measured the 5 personality domains, the Leiden Index of Depression Sensitivity-Revised was used to measure cognitive reactivity (eg, hopelessness, rumination), and the Mastery Scale measured external locus of control.
Compared to the nonchronically depressed persons, the chronically depressed persons reported significantly higher levels of neuroticism (OR = 1.81; 95% CI, 1.55-2.12; P < .001), external locus of control (OR = 1.94; 95% CI, 1.66-2.28; P < .001), and the following dimensions of cognitive reactivity: hopelessness (OR = 1.64; 95% CI, 1.43-1.88; P < .001), aggression (OR = 1.29; 95% CI, 1.13-1.48; P < .001), risk aversion (OR = 1.43; 95% CI, 1.24-1.63; P < .001), and rumination (OR = 1.55; 95% CI, 1.34-1.78; P < .001). They had significantly lower levels of extraversion (OR = 0.57; 95% CI, 0.49-0.67; P < .001), agreeableness (OR = 0.85; 95% CI, 0.74-0.97; P = .02), and conscientiousness (OR = 0.77; 95% CI, 0.67-0.88; P < .001). When testing these variables multivariably, the odds of chronic depression were significantly increased among those with low extraversion (OR = 0.73; 95% CI, 0.61-0.88; P = .001), high rumination (OR = 1.24; 95% CI, 1.01-1.53; P = .04), and high external locus of control (OR = 1.48; 95% CI, 1.21-1.80; P < .001). Controlling for severity of depressive symptoms, age at onset, comorbidity with anxiety disorders, medical illnesses, and treatment status did not change these results.
Our findings suggest that extraversion, rumination, and external locus of control, but not neuroticism, are differentiating psychological characteristics for chronicity of depression. These findings provide suggestions for more specific interventions, focused on extraversion, rumination, and external locus of control, in the treatment of chronic depression.
很少有研究调查心理特征对抑郁症慢性的重要性。了解慢性抑郁患者与非慢性抑郁患者之间的心理差异，可能有助于改善慢性抑郁症的治疗。这是第一项同时在大样本中比较慢性和非慢性抑郁成年人各种心理特征的研究。
本研究的数据来自荷兰抑郁与焦虑研究（NESDA），这是一项正在进行的纵向队列研究，旨在研究不同医疗保健环境和疾病阶段中抑郁和焦虑障碍的长期病程。参与者在 2004-2007 年基线评估时年龄在 18 至 65 岁之间，目前被诊断为 DSM-IV 重性抑郁障碍（N=1002）。抑郁症的慢性程度定义为过去 4 至 5 年内有 24 个月或更长时间的抑郁。31%（n=312）的患者符合慢性标准。使用 NEO 五因素人格量表测量 5 种人格维度，使用莱顿抑郁敏感反应修订版量表测量认知反应（如绝望、沉思），使用掌握量表测量外部控制源。
与非慢性抑郁患者相比，慢性抑郁患者报告的神经质水平显著更高（OR=1.81；95%CI，1.55-2.12；P<.001），外部控制源（OR=1.94；95%CI，1.66-2.28；P<.001），以及以下认知反应维度：绝望（OR=1.64；95%CI，1.43-1.88；P<.001）、攻击性（OR=1.29；95%CI，1.13-1.48；P<.001）、风险规避（OR=1.43；95%CI，1.24-1.63；P<.001）和沉思（OR=1.55；95%CI，1.34-1.78；P<.001）。他们的外向性水平显著降低（OR=0.57；95%CI，0.49-0.67；P<.001），宜人性（OR=0.85；95%CI，0.74-0.97；P=0.02）和尽责性（OR=0.77；95%CI，0.67-0.88；P<.001）。当多变量检验这些变量时，低外向性（OR=0.73；95%CI，0.61-0.88；P=0.001）、高沉思（OR=1.24；95%CI，1.01-1.53；P=0.04）和高外部控制源（OR=1.48；95%CI，1.21-1.80；P<.001）的人发生慢性抑郁症的几率显著增加。在控制抑郁症状严重程度、发病年龄、焦虑障碍共病、医疗疾病和治疗状况后，这些结果并没有改变。
我们的研究结果表明，外向性、沉思和外部控制源，而不是神经质，是抑郁症慢性的区别性心理特征。这些发现为慢性抑郁症的治疗提供了建议，即针对外向性、沉思和外部控制源进行更具体的干预。
