Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands.
Psychol Med. 2012 Apr;42(4):695-703. doi: 10.1017/S0033291711001681. Epub 2011 Aug 26.
Previous studies suggest that alcohol-use disorder severity, defined by the number of criteria met, provides a more informative phenotype than dichotomized DSM-IV diagnostic measures of alcohol use disorders. Therefore, this study examined whether alcohol-use disorder severity predicted first-incident depressive disorders, an association that has never been found for the presence or absence of an alcohol use disorder in the general population.
In a national sample of persons who had never experienced a major depressive disorder (MDD), dysthymia, manic or hypomanic episode (n=27 571), we examined whether a version of DSM-5 alcohol-use disorder severity (a count of three abuse and all seven dependence criteria) linearly predicted first-incident depressive disorders (MDD or dysthymia) after 3-year follow-up. Wald tests were used to assess whether more complicated models defined the relationship more accurately.
First-incidence of depressive disorders varied across alcohol-use disorder severity and was 4.20% in persons meeting no alcohol-use disorder criteria versus 44.47% in persons meeting all 10 criteria. Alcohol-use disorder severity significantly predicted first-incidence of depressive disorders in a linear fashion (odds ratio 1.14, 95% CI 1.06-1.22), even after adjustment for sociodemographics, smoking status and predisposing factors for depressive disorders, such as general vulnerability factors, psychiatric co-morbidity and subthreshold depressive disorders. This linear model explained the relationship just as well as more complicated models.
Alcohol-use disorder severity was a significant linear predictor of first-incident depressive disorders after 3-year follow-up and may be useful in identifying a high-risk group for depressive disorders that could be targeted by prevention strategies.
先前的研究表明，根据符合的标准数量定义的酒精使用障碍严重程度，比 DSM-IV 酒精使用障碍的二分诊断测量提供了更具信息量的表型。因此，本研究检验了酒精使用障碍严重程度是否预测首发抑郁障碍，而在普通人群中，从未发现过存在或不存在酒精使用障碍与首发抑郁障碍之间存在这种关联。
在一个从未经历过重度抑郁症（MDD）、恶劣心境、躁狂或轻躁狂发作的人群的全国性样本中（n=27571），我们检验了 DSM-5 酒精使用障碍严重程度（符合三个滥用和所有七个依赖标准的计数）是否在 3 年随访后线性预测首发抑郁障碍（MDD 或恶劣心境）。Wald 检验用于评估更复杂的模型是否更准确地定义了这种关系。
首发抑郁障碍在酒精使用障碍严重程度上有所不同，符合无酒精使用障碍标准的人群为 4.20%，而符合所有 10 项标准的人群为 44.47%。酒精使用障碍严重程度以线性方式显著预测首发抑郁障碍（比值比 1.14，95%置信区间 1.06-1.22），即使在调整了社会人口统计学、吸烟状况以及抑郁障碍的易患因素（如一般易感性因素、精神共病和阈下抑郁障碍）后也是如此。这种线性模型解释了这种关系，与更复杂的模型一样好。
酒精使用障碍严重程度是 3 年后首发抑郁障碍的显著线性预测因子，可用于识别可能成为预防策略目标的抑郁障碍高危人群。
