Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Switzerland.
Department of Psychology, University of Zurich, and Department of Psychology, University of Bern, Switzerland.
J Affect Disord. 2014 Mar;156:92-103. doi: 10.1016/j.jad.2013.11.021. Epub 2013 Dec 10.
Reducing the complexity of major depressive disorder by symptom-based subtypes constitutes the basis of more specific treatments. To date, few studies have empirically derived symptom subtypes separated by sex, although the impact of sex has been widely accepted in depression research.
The community-based sample included 373 males and 443 females from the Zurich Program for Sustainable Development of Mental Health Services (ZInEP) manifesting depressive symptoms in the past 12 months. Latent Class Analysis (LCA) was performed separately by sex to extract sex-related depression subtypes. The subtypes were characterized by psychosocial characteristics.
Three similar subtypes were found in both sexes: a severe typical subtype (males: 22.8%; females: 35.7%), a severe atypical subtype (males: 17.4%; females: 22.6%), and a moderate subtype (males: 25.2%; females: 41.8%). In males, two additional subgroups were identified: a severe irritable/angry-rejection sensitive (IARS) subtype (30%) comprising the largest group, and a small psychomotor retarded subtype (4%). Males belonging to the severe typical subtype exhibited the lowest masculine gender role orientation, while females of the typical subtype showed more anxiety disorders. The severe atypical subtype was associated with eating disorders in both sexes and with alcohol/drug abuse/dependence in females. In contrast, alcohol/drug abuse/dependence was associated with the severe IARS subtype in males.
The study had a cross-sectional design, allowing for no causal inferences.
This study contributes to a better understanding of sex-related depression subtypes, which can be well distinguished on the basis of symptom profiles. This provides the base for future research investigating the etiopathogenesis and effective treatment of the heterogeneous depression disorder.
基于症状的亚型来降低重度抑郁症的复杂性是更具针对性治疗的基础。迄今为止，尽管性别因素在抑郁症研究中已得到广泛认可，但很少有研究从实证角度得出按性别划分的症状亚型。
该基于社区的样本包括来自苏黎世精神卫生服务可持续发展计划（ZInEP）的 373 名男性和 443 名女性，他们在过去 12 个月中表现出抑郁症状。分别对男性和女性进行潜在类别分析（LCA），以提取与性别相关的抑郁亚型。这些亚型的特点是具有社会心理特征。
在两性中均发现了三种相似的亚型：严重典型亚型（男性：22.8%；女性：35.7%）、严重非典型亚型（男性：17.4%；女性：22.6%）和中度亚型（男性：25.2%；女性：41.8%）。在男性中，还确定了另外两个亚组：一个严重易怒/易激惹-拒绝敏感（IARS）亚型（30%），这是最大的组，以及一个较小的精神运动迟缓亚型（4%）。属于严重典型亚型的男性表现出最低的男性性别角色取向，而典型亚型的女性则表现出更多的焦虑障碍。严重非典型亚型在两性中均与饮食障碍有关，在女性中与酒精/药物滥用/依赖有关。相比之下，酒精/药物滥用/依赖与男性中的严重 IARS 亚型有关。
该研究为横断面设计，不允许进行因果推断。
本研究有助于更好地理解与性别相关的抑郁亚型，这些亚型可以根据症状特征进行很好地区分。这为未来研究异质抑郁症的发病机制和有效治疗提供了基础。
