Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands.
J Affect Disord. 2012 Feb;136(3):505-13. doi: 10.1016/j.jad.2011.10.041. Epub 2011 Nov 25.
The authors examined an additive model for the association of life events and age with onset of major depressive disorder (MDD) and whether the combination of life events and age posed greater risk than the sum of their independent effects.
Data were used from a prospective cohort study of 10,045 general practice attendees (PredictD). We included those without MDD at baseline (N=8293). We examined age divided into tertiles and into 10 year groups. Life events were assessed at baseline using the List of Threatening Life Experiences Questionnaire and categorized according to type. Main outcome measure was onset of DSM-IV MDD at 6 or 12 months of follow-up. The authors calculated Relative Excess Risks due to Interaction (RERI).
6910 persons (83.3%) had a complete follow-up, of whom 589 (8.5%) had an onset of MDD (166 younger, 254 middle aged and 169 older). The combined effect of personal problems (RERI=1.30; 95% CI 0.29 to 2.32), events in family or friends (RERI=1.23; 95% CI 0.28 to 2.19), or problems with law (RERI=1.57; 95% CI 0.33 to 2.82) and middle age was larger than the sum of individual effects.
Lower response to recruitment in the UK and the Netherlands.
Recent life events carry the largest risk of onset of MDD in mid-life. Understanding the different vulnerability to life events according to age may help to indicate groups at a particular risk and assist in preventive strategies.
作者研究了生活事件和年龄与重性抑郁障碍（MDD）发病的相加模型，以及生活事件和年龄的组合是否比它们各自独立的影响之和具有更大的风险。
本研究数据来自一项前瞻性队列研究（PredictD），共纳入了 10045 名普通诊所就诊者。我们纳入了基线时无 MDD 的患者（N=8293）。我们根据年龄将患者分为三分位数和 10 年组，使用威胁生命事件清单（List of Threatening Life Experiences Questionnaire）在基线时评估生活事件，并根据类型进行分类。主要结局指标为 DSM-IV MDD 在 6 或 12 个月随访时的发病情况。作者计算了交互作用的相对超额风险（Relative Excess Risks due to Interaction，RERI）。
6910 人（83.3%）完成了完整的随访，其中 589 人（8.5%）发生了 MDD（年轻组 166 人，中年组 254 人，老年组 169 人）。个人问题（RERI=1.30；95%可信区间 0.29 至 2.32）、家庭或朋友中的事件（RERI=1.23；95%可信区间 0.28 至 2.19）、法律问题（RERI=1.57；95%可信区间 0.33 至 2.82）与中年的联合效应大于个体效应的总和。
英国和荷兰的招募反应率较低。
近期生活事件是中年 MDD 发病的最大风险因素。根据年龄了解对生活事件的不同易感性可能有助于确定特定风险人群，并为预防策略提供依据。
