Park Seon-Cheol, Hahn Sang-Woo, Hwang Tae-Yeon, Kim Jae-Min, Jun Tae-Youn, Lee Min-Soo, Kim Jung-Bum, Yim Hyeon-Woo, Park Yong Chon
Department of Psychiatry, Yong-In Mental Hospital, Yongin, Korea.; Institute of Mental Health, Hanyang University, Seoul, Korea.
Department of Psychiatry, College of Medicine, Soonchunhyang Univeristy, Seoul Hospital, Seoul, Korea.
Yonsei Med J. 2014 Nov;55(6):1712-20. doi: 10.3349/ymj.2014.55.6.1712.
The purpose of this study was to evaluate the effects of age at onset of the first major depressive episode on the clinical features of individuals with major depressive disorder (MDD) in a large cohort of Korean depressed patients.
We recruited 419 MDD patients of age over 18 years from the Clinical Research Center for Depression study in South Korea. At the start of the study, the onset age of the first major depressive episode was self-reported by the subjects. The subjects were divided into four age-at-onset subgroups: childhood and adolescent onset (ages <18), early adult onset (ages 18-44), middle adult onset (ages 45-59), and late onset (ages 60+). Using analysis of covariance (ANCOVA) and ordinal logistic regression analysis with adjusting the effect of age, the relationships between clinical features and age at onset of MDD were evaluated.
There was an apparent, but inconsistent correlation between clinical features and age at onset. Earlier onset MDD was significantly associated with higher proportion of female gender [adjusted odds ratio (AOR)=0.570, p=0.022], more previous suicide attempts (AOR=0.635, p=0.038), greater number of previous depressive episodes (F=3.475, p=0.016) and higher scores on the brief psychiatric rating scale (F=3.254, p=0.022), its negative symptom subscale (F=6.082, p<0.0001), and the alcohol use disorder identification test (F=7.061, p<0.0001).
Early age at onset may increase the likelihood of distinguishable MDD subtype, and age at onset of the first major depressive episode is a promising clinical indicator for the clinical presentation, course, and outcome of MDD.
本研究旨在评估韩国一大群抑郁症患者中首次重度抑郁发作的发病年龄对重度抑郁症（MDD）患者临床特征的影响。
我们从韩国抑郁症临床研究中心招募了419名年龄超过18岁的MDD患者。在研究开始时，由受试者自行报告首次重度抑郁发作的发病年龄。受试者被分为四个发病年龄亚组：儿童及青少年期发病（年龄<18岁）、成年早期发病（年龄18 - 44岁）、成年中期发病（年龄45 - 59岁）和晚期发病（年龄60岁及以上）。使用协方差分析（ANCOVA）和序贯逻辑回归分析，并调整年龄的影响，评估MDD临床特征与发病年龄之间的关系。
临床特征与发病年龄之间存在明显但不一致的相关性。发病较早的MDD与女性比例较高显著相关[调整优势比（AOR）=0.570，p = 0.022]、既往自杀未遂次数较多（AOR = 0.635，p = 0.038）、既往抑郁发作次数较多（F = 3.475，p = 0.016）以及简明精神病评定量表得分较高（F = 3.254，p = 0.022）、其阴性症状分量表得分较高（F = 6.082，p < 0.0001）和酒精使用障碍识别测试得分较高（F = 7.061，p < 0.0001）有关。
发病年龄较早可能会增加可区分的MDD亚型的可能性，首次重度抑郁发作的发病年龄是MDD临床表现、病程和结局有前景的临床指标。
