重性抑郁障碍的复发:概念分析。

Recurrence in major depression: a conceptual analysis.

机构信息

Department of Psychology, University of Notre Dame, 119C Haggar Hall, Notre Dame, IN 46556, USA.

出版信息

Psychol Rev. 2011 Oct;118(4):655-74. doi: 10.1037/a0025190.

Abstract

Theory and research on major depression have increasingly assumed a recurrent and chronic disease model. Yet not all people who become depressed suffer recurrences, suggesting that depression is also an acute, time-limited condition. However, few if any risk indicators are available to forecast which of the initially depressed will or will not recur. This prognostic impasse may be a result of problems in conceptualizing the nature of recurrence in depression. In the current paper we first provide a conceptual analysis of the assumptions and theoretical systems that presently structure thinking on recurrence. This analysis reveals key concerns that have distorted views about the long-term course of depression. Second, as a consequence of these theoretical problems we suggest that investigative attention has been biased toward recurrent forms of depression and away from acute, time-limited conditions. Third, an analysis of how these theoretical problems have influenced research practices reveals that an essential comparison group has been omitted from research on recurrence: people with a single lifetime episode of depression. We suggest that this startling omission may explain why so few predictors of recurrence have as yet been found. Finally, we examine the reasons for this oversight, document the validity of depression as an acute, time-limited disorder, and provide suggestions for future research with the goal of discovering early risk indicators for recurrent depression.

摘要

关于重度抑郁症的理论和研究越来越多地假设为复发性和慢性疾病模型。然而,并非所有抑郁的人都会复发,这表明抑郁也是一种急性、限时的病症。然而,几乎没有任何风险指标可以预测最初抑郁的人是否会复发。这种预后僵局可能是由于对抑郁症复发性质的概念化存在问题。在当前的论文中,我们首先对目前构成关于复发思维的假设和理论体系进行了概念分析。该分析揭示了关键问题,这些问题扭曲了对抑郁症长期病程的看法。其次,由于这些理论问题,我们认为研究关注的重点已经偏向于复发性抑郁症,而不是急性、限时的情况。第三,对这些理论问题如何影响研究实践的分析表明,在关于复发的研究中遗漏了一个重要的对照组:单次发作的抑郁症患者。我们认为,这种惊人的遗漏可能解释了为什么迄今为止发现的复发预测因子如此之少。最后,我们探讨了这种忽视的原因,证明了抑郁症作为一种急性、限时疾病的有效性,并为未来的研究提供了建议,以发现复发性抑郁症的早期风险指标。

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