Department of Family and Community Medicine, Meharry Medical College, Nashville, Tennessee, USA; Center for Molecular and Behavioral Neuroscience, Meharry Medical College, Nashville, Tennessee, USA.
Br J Clin Psychol. 2014 Jun;53(2):245-63. doi: 10.1111/bjc.12038. Epub 2013 Dec 27.
This prospective study investigated whether within-individual relations between depression vulnerability factors (childhood trauma, dysfunctional attitudes, maladaptive coping) and depressive symptom trajectories varied as a function of the number of prior major depressive episodes (MDEs) experienced in their lifetime.
Participants were 68 young adults who varied with regard to their history of depression; 32 were remitted depressed and 36 were never depressed.
Depressive symptoms and disorders were assessed using semi-structured psychiatric interviews conducted twice over a 6-month period; interviews yielded weekly ratings of depressive symptoms during the follow-up interval. Childhood trauma, dysfunctional attitudes and coping were assessed with self-report measures. Data analyses were conducted using time-lagged multilevel models.
Individuals with more previous MDEs who reported greater childhood trauma exposure, more dysfunctional attitudes, or greater use of maladaptive coping strategies experienced more rapid increases in depressive symptoms during the follow-up period. A significant interaction of coping, number of previous MDEs, and time was found indicating that among individuals with less adaptive coping (i.e., lower primary or lower secondary control coping scores), depressive symptoms rating (DSR) increased significantly in relation to number of prior depressive episodes; no change in DSR was observed for never-depressed individuals. Among individuals with higher primary control coping scores, significant increases in DSR scores were observed for individuals with ≥3 prior MDEs only.
Findings highlight the need for treatment and prevention programmes that target stress reactivity and coping strategies early in the course of depression.
本前瞻性研究旨在探讨个体内在的抑郁易感性因素（童年创伤、功能失调态度、适应不良应对方式）与抑郁症状轨迹之间的关系是否因一生中经历的先前重度抑郁发作（MDE）次数的不同而有所变化。
参与者为 68 名年轻成年人，他们的抑郁史各不相同；其中 32 名是缓解期抑郁患者，36 名从未患过抑郁症。
使用半结构式精神科访谈在 6 个月的时间内进行两次评估，评估抑郁症状和障碍；在随访期间每周对抑郁症状进行评级。使用自我报告的方法评估童年创伤、功能失调态度和应对方式。使用时间滞后的多层模型进行数据分析。
有更多先前 MDE 的个体报告有更多的童年创伤经历、更多的功能失调态度或更多的适应不良应对策略，在随访期间其抑郁症状的增加速度更快。发现应对方式、先前 MDE 次数和时间之间存在显著的交互作用，表明在应对方式适应性较差的个体（即初级控制或次级控制应对得分较低）中，与先前抑郁发作次数相关的抑郁症状评分（DSR）显著增加；从未患过抑郁症的个体没有观察到 DSR 的变化。在初级控制应对得分较高的个体中，仅观察到先前 MDE 次数≥3 的个体 DSR 得分显著增加。
研究结果强调了需要针对应激反应和应对策略的治疗和预防方案，在抑郁的早期阶段就开始实施。
