Dew M A, Roth L H, Switzer G E, Schulberg H C, Simmons R G, Kormos R L, Griffith B P
Department of Psychiatry, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, Pennsylvania.
J Clin Psychol Med Settings. 1996 Dec;3(4):367-86. doi: 10.1007/BF01994020.
The study provides the first empirical evaluation of gender differences in psychological symptomatology and DSM-III-R major depressive disorder (MDD) across the first year following heart transplantation. An important goal was to identify physical health-related and psychosocial factors that could account for, or mediate, any association between gender and psychological distress. The sample for the present analyses was drawn from a larger cohort of 172 heart recipients and included all 28 women in the cohort plus 118 men who were matched demographically with the group of women. Detailed patient assessments were completed at 2, 7, and 12 months posttransplant. As expected, women's symptom levels were consistently higher than men's. However, while men's symptom levels in all areas declined with time posttransplant, women's distress in the area of depression initially improved but then worsened by the 12-month assessment. The distribution of episodes of MDD showed a temporal pattern of gender differences similar to that of depressive symptoms. The most important mediators of the gender-depression relationship were factors related to early posttransplant daily functional limitations: women reported more impairments in daily activities. Higher levels of such impairments, in turn, predicted subsequently higher depression levels by 12 months posttransplant. Several additional variables pertaining to transplant-related concerns and a low sense of personal mastery-while not serving as mediators-exerted their own independent effects on 12-month depression levels. The findings are relevant to the tailoring of educational and clinical interventions to the individual needs of women and men who receive heart transplants.
该研究首次对心脏移植后第一年中心理症状和《精神疾病诊断与统计手册》第三版修订本（DSM-III-R）中重度抑郁症（MDD）的性别差异进行了实证评估。一个重要目标是确定与身体健康相关的因素和社会心理因素，这些因素可以解释或调节性别与心理困扰之间的任何关联。本分析的样本取自一个由172名心脏移植受者组成的更大队列，包括该队列中的所有28名女性以及118名在人口统计学上与女性组匹配的男性。在移植后2个月、7个月和12个月完成了详细的患者评估。正如预期的那样，女性的症状水平一直高于男性。然而，虽然男性在所有领域的症状水平随着移植后的时间而下降，但女性在抑郁领域的困扰最初有所改善，但在12个月评估时恶化。MDD发作的分布显示出与抑郁症状相似的性别差异时间模式。性别与抑郁关系的最重要调节因素是与移植后早期日常功能限制相关的因素：女性报告在日常活动中有更多障碍。反过来，更高水平的此类障碍预示着移植后12个月时抑郁水平会更高。与移植相关的担忧和较低的个人掌控感等几个额外变量——虽然不是调节因素——对12个月时的抑郁水平产生了各自独立的影响。这些发现与根据接受心脏移植的女性和男性的个体需求定制教育和临床干预措施相关。
