Department of Psychology , University of Denver, CO 80208, USA.
J Clin Child Adolesc Psychol. 2012;41(5):695-718. doi: 10.1080/15374416.2012.711708. Epub 2012 Aug 17.
Depression is a developmental phenomenon. Considerable progress has been made in describing the syndrome, establishing its prevalence and features, providing clues as to its etiology, and developing evidence-based treatment and prevention options. Despite considerable headway in distinct lines of vulnerability research, there is an explanatory gap in the field's ability to more comprehensively explain and predict who is likely to become depressed, when, and why. Still, despite clear success in predicting moderate variance for future depression, especially with empirically rigorous methods and designs, the heterogeneous and multi-determined nature of depression suggests that additional etiologies need to be included to advance knowledge on developmental pathways to depression. This paper advocates for a multiple levels of analysis approach to investigating vulnerability to depression across the lifespan and providing a more comprehensive understanding of its etiology. One example of a multiple levels of analysis model of vulnerabilities to depression is provided that integrates the most accessible, observable factors (e.g., cognitive and temperament risks), intermediate processes and endophenotypes (e.g., information-processing biases, biological stress physiology, and neural activation and connectivity), and genetic influences (e.g., candidate genes and epigenetics). Evidence for each of these factors as well as their cross-level integration is provided. Methodological and conceptual considerations important for conducting integrative, multiple levels of depression vulnerability research are discussed. Finally, translational implications for how a multiple levels of analysis perspective may confer additional leverage to reduce the global burden of depression and improve care are considered.
抑郁是一种发展现象。在描述这种综合征、确定其普遍性和特征、提供病因线索以及开发基于证据的治疗和预防方法方面已经取得了相当大的进展。尽管在不同的易损性研究领域取得了相当大的进展，但该领域在更全面地解释和预测谁可能会患上抑郁症、何时以及为何患上抑郁症方面仍存在解释差距。尽管通过经验严格的方法和设计，在预测未来抑郁症的中度变异性方面取得了明显的成功，但抑郁症的异质性和多决定性质表明，需要纳入更多的病因来推进对抑郁症发展途径的知识。本文主张采用多层次分析方法来研究整个生命周期中对抑郁症的易感性，并提供对其病因的更全面理解。本文提供了一个多层次分析模型的例子，该模型整合了最易接近、可观察的因素（例如认知和气质风险）、中间过程和内表型（例如信息处理偏差、生物应激生理学以及神经激活和连通性）以及遗传影响（例如候选基因和表观遗传学）。提供了这些因素及其跨层次整合的证据。讨论了进行综合多层次抑郁症易感性研究的重要方法学和概念考虑因素。最后，考虑了从多层次分析角度可能会增加减轻全球抑郁症负担和改善护理的额外影响力的转化意义。
