New York State Psychiatric Institute, New York, NY 10032, USA.
J Affect Disord. 2013 Sep 25;150(3):1179-83. doi: 10.1016/j.jad.2013.05.010. Epub 2013 Jun 2.
Estimating the likelihood of future major depressive episodes (MDEs) would assist clinicians in decision-making regarding the optimal length of treatment for MDE. Unfortunately, little data are available to guide clinical practice.
We followed 200 females and 152 males who responded to treatment for a MDE for 2 years to determine risk factors for future MDE. Cox Proportional Hazard Regression modeled time to first relapse into MDE and mixed effect logistic regression modeled monthly depression status.
Females were more likely than males to experience a MDE in any month of the study, and marginally more likely to experience a relapse. By 12 months, 60% of females had relapsed compared to 51% of males (median time to relapse 8 vs. 13 months, respectively). Several factors predicted worse outcome for both men and women: reported childhood abuse, earlier age of onset of first MDE, bipolar disorder, unemployment, and more years of education. For females, but not males, suicidal ideation predicted MDE relapse and both suicidal ideation and prior suicide attempts were associated with more time in a MDE.
The naturalistic treatment of participants, exclusion of individuals with current comorbid alcohol or substance use disorder, and a follow up period of two years are limitations.
Women are more vulnerable to relapse and spend more time depressed compared to men. Identification of general and sex-specific risk factors for future depression may provide clinicians with useful tools to estimate need for ongoing pharmacotherapy in MDE.
预测未来重度抑郁发作（MDE）的可能性将有助于临床医生针对 MDE 的最佳治疗时长做出决策。遗憾的是，目前可用的数据很少，无法为临床实践提供指导。
我们对 200 名女性和 152 名男性进行了为期 2 年的随访，这些患者对 MDE 进行了治疗，以确定未来 MDE 的风险因素。Cox 比例风险回归模型用于预测首次复发进入 MDE 的时间，混合效应逻辑回归模型用于预测每月的抑郁状态。
女性在研究的任何一个月中出现 MDE 的可能性都高于男性，且更有可能复发。到 12 个月时，60%的女性出现了复发，而男性的这一比例为 51%（中位复发时间分别为 8 个月和 13 个月）。几个因素预测了男性和女性的预后都更差：报告的童年期虐待、首次 MDE 发病年龄更早、双相情感障碍、失业和受教育年限更长。对于女性，但不是男性，自杀意念预测了 MDE 的复发，自杀意念和既往自杀企图与 MDE 持续时间更长有关。
参与者接受的是自然主义治疗，排除了当前患有共病酒精或物质使用障碍的个体，以及随访时间仅为 2 年，这些都是本研究的局限性。
与男性相比，女性更容易复发，且抑郁时间更长。确定未来抑郁的一般和性别特异性风险因素，可能为临床医生提供有用的工具，用于评估 MDE 中持续药物治疗的需求。
