Jeon Hong Jin, Walker Rosemary S, Inamori Aya, Hong Jin Pyo, Cho Maeng Je, Baer Lee, Clain Alisabet, Fava Maurizio, Mischoulon David
aDepartment of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine bDepartment of Psychiatry, Asan Medical Center, Ulsan University College of Medicine cDepartment of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea dDepression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Int Clin Psychopharmacol. 2014 May;29(3):150-6. doi: 10.1097/YIC.0000000000000019.
Previous epidemiologic studies have revealed that East-Asian populations experience fewer depressive symptoms than American populations do. However, it is unclear whether this difference applies to clinical patients with major depressive disorder (MDD). This present study included 1592 Korean and 3744 American outpatients who were 18 years of age or older and met the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. criteria for single or recurrent episodes of nonpsychotic MDD, and evaluated their symptoms of depression using the Hamilton Depression Rating Scale and the Quality of Life Enjoyment and Satisfaction Questionnaire Short Form. Korean patients scored significantly lower for guilt and depressed mood items, and higher for hypochondriasis and suicidality items than American patients did, after adjusting for total Hamilton Depression Rating Scale scores. Conversely, no significant differences were found in quality and function of daily life between groups. Multivariate logistic regression analyses revealed that Korean patients experienced less frequent depressed mood and guilt, including verbal and nonverbal expression of depressed mood [adjusted odds ratio (AOR) = 0.14, 95% confidence interval (CI) 0.08-0.23] and feelings of punishment (AOR = 0.036, 95% CI 0.025-0.054) when compared with Americans after adjusting for age and sex. Conversely, Korean patients experienced more frequent suicidality and hypochondriasis, including suicidal ideas or gestures (AOR = 2.10, 95% CI 1.60-2.76) and self-absorption of hypochondriasis (AOR = 1.94, 95% CI 1.70-2.20). In conclusion, decreased expression of depressed mood and guilt may cause underdiagnosis of MDD in Korean patients. Early diagnosis of and intervention for depression and suicide may be delayed because of this specific cross-cultural difference in depression symptoms.
以往的流行病学研究表明，东亚人群比美国人群经历的抑郁症状更少。然而，这种差异是否适用于重度抑郁症（MDD）临床患者尚不清楚。本研究纳入了1592名韩国门诊患者和3744名美国门诊患者，这些患者年龄在18岁及以上，符合《精神疾病诊断与统计手册》第4版中关于非精神病性MDD单次或复发发作的标准，并使用汉密尔顿抑郁量表和生活质量享受与满意度问卷简表评估他们的抑郁症状。在对汉密尔顿抑郁量表总分进行调整后，韩国患者在罪恶感和抑郁情绪项目上的得分显著低于美国患者，而在疑病症和自杀观念项目上的得分则高于美国患者。相反，两组在日常生活质量和功能方面未发现显著差异。多因素逻辑回归分析显示，在对年龄和性别进行调整后，与美国患者相比，韩国患者出现抑郁情绪和罪恶感的频率较低，包括抑郁情绪的言语和非言语表达（调整后的优势比[AOR]=0.14，95%置信区间[CI]0.08-0.23）以及受惩罚感（AOR=0.036，95%CI0.025-0.054）。相反，韩国患者出现自杀观念和疑病症的频率较高，包括自杀想法或行为（AOR=2.10，95%CI1.60-2.76）以及疑病症的自我专注（AOR=1.94，95%CI1.70-2.20）。总之，抑郁情绪和罪恶感表达的减少可能导致韩国患者MDD诊断不足。由于这种抑郁症状的特定跨文化差异，抑郁症和自杀的早期诊断及干预可能会延迟。
