Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands; Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences and Brain Center Rudolf Magnus, Utrecht University, Utrecht, The Netherlands.
Depress Anxiety. 2014 Sep;31(9):737-45. doi: 10.1002/da.22262. Epub 2014 Apr 17.
Even though traumatic stress is a major risk factor for depression, most people do not develop a depression. The effects of stress may particularly emerge after repeated exposure in vulnerable individuals. Therefore, we hypothesized that (1) increased exposure to stress across the life span is associated with an increased depression risk and (2) this effect is the most pronounced in individuals with high levels of neuroticism.
We investigated the effect of childhood maltreatment, major life events, daily hassles, and a composite index thereof (cumulative stress index) on depressive symptoms and major depressive disorder (MDD) including the possible moderating role of neuroticism in a discovery sample from the general population (N = 563) and an independent replication sample from the Netherlands Study of Depression and Anxiety (N = 2,274).
All stress domains were independently associated with depressive symptoms in the discovery sample. In the replication sample, we confirmed these findings for childhood maltreatment and daily hassles but not for major life events with depressive symptoms as outcome. Nevertheless, all stress domains significantly contributed to the presence of MDD in the replication sample. The cumulative stress index was significantly associated with depression in the discovery (β = 1.42, P < .001) and replication sample (β = 3.79, P < .001), especially in those individuals with high levels of trait neuroticism (discovery: β = 0.013, P < .001; replication: β = 0.367, P < .001).
This is the first study to show that cumulative stress exposure across different stress domains contributes to depressive symptoms and MDD in adulthood. Moreover, we show that increased exposure to stress across the life span has more impact on vulnerable individuals with high levels of trait neuroticism.
尽管创伤后应激是抑郁的一个主要危险因素，但大多数人并不会患上抑郁症。在易受伤害的个体中，压力的影响可能会在反复暴露后尤其显现出来。因此，我们假设：(1) 一生中接触压力的增加与抑郁风险的增加有关；(2) 这种效应在神经质水平较高的个体中最为明显。
我们研究了童年期虐待、重大生活事件、日常困扰以及它们的综合指数（累积压力指数）对抑郁症状和重性抑郁障碍（MDD）的影响，包括神经质在一般人群的发现样本（N=563）和荷兰抑郁与焦虑研究（N=2274）中的独立复制样本中的可能调节作用。
在发现样本中，所有压力领域都与抑郁症状独立相关。在复制样本中，我们确认了童年期虐待和日常困扰与抑郁症状的这些发现，但重大生活事件与抑郁症状的结果无关。然而，所有压力领域在复制样本中都显著导致了 MDD 的出现。累积压力指数与发现样本（β=1.42，P<.001）和复制样本（β=3.79，P<.001）中的抑郁显著相关，尤其是在神经质水平较高的个体中（发现样本：β=0.013，P<.001；复制样本：β=0.367，P<.001）。
这是第一项表明不同压力领域的累积压力暴露会导致成年后抑郁症状和 MDD 的研究。此外，我们表明，一生中接触压力的增加对神经质水平较高的易受伤害个体的影响更大。
