Marwaha Steven, Balbuena Lloyd, Winsper Catherine, Bowen Rudy
Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK Early Intervention Service, Coventry, UK
Department of Psychiatry, University of Saskatchewan, Saskatoon, SK, Canada Administrative Data Research Network Wales, Swansea University, Wales, UK.
Aust N Z J Psychiatry. 2015 Jun;49(6):557-65. doi: 10.1177/0004867415579920. Epub 2015 Apr 7.
Mood instability levels are high in depression, but temporal precedence and potential mechanisms are unknown. Hypotheses tested were as follows: (1) mood instability is associated with depression cross-sectionally, (2) mood instability predicts new onset and maintenance of depression prospectively and (3) the mood instability and depression link are mediated by sleep problems, alcohol abuse and life events.
Data from the National Psychiatric Morbidity Survey 2000 at baseline (N = 8580) and 18-month follow-up (N = 2413) were used. Regression modeling controlling for socio-demographic factors, anxiety and hypomanic mood was conducted. Multiple mediational analyses were used to test our conceptual path model.
Mood instability was associated with depression cross-sectionally (odds ratio: 5.28; 95% confidence interval: [3.67, 7.59]; p < 0.001) and predicted depression inception (odds ratio: 2.43; 95% confidence interval: [1.03-5.76]; p = 0.042) after controlling for important confounders. Mood instability did not predict maintenance of depression. Sleep difficulties and severe problems with close friends and family significantly mediated the link between mood instability and new onset depression (23.05% and 6.19% of the link, respectively). Alcohol abuse and divorce were not important mediators in the model.
Mood instability is a precursor of a depressive episode, predicting its onset. Difficulties in sleep are a significant part of the pathway. Interventions targeting mood instability and sleep problems have the potential to reduce the risk of depression.
抑郁症患者的情绪不稳定程度较高，但时间先后顺序及潜在机制尚不清楚。所检验的假设如下：（1）情绪不稳定与抑郁症存在横断面关联；（2）情绪不稳定可前瞻性预测抑郁症的新发和持续存在；（3）情绪不稳定与抑郁症之间的联系由睡眠问题、酒精滥用和生活事件介导。
使用2000年全国精神病发病率调查基线（N = 8580）和18个月随访（N = 2413）的数据。进行了控制社会人口统计学因素、焦虑和轻躁狂情绪的回归建模。采用多重中介分析来检验我们的概念路径模型。
在控制重要混杂因素后，情绪不稳定与抑郁症存在横断面关联（比值比：5.28；95%置信区间：[3.67, 7.59]；p < 0.001），并可预测抑郁症的发病（比值比：2.43；95%置信区间：[1.03 - 5.76]；p = 0.042）。情绪不稳定不能预测抑郁症的持续存在。睡眠困难以及与亲密朋友和家人的严重问题显著介导了情绪不稳定与新发抑郁症之间的联系（分别占该联系的23.05%和6.19%）。酒精滥用和离婚在该模型中不是重要的中介因素。
情绪不稳定是抑郁发作的先兆，可预测其发作。睡眠困难是该途径的重要组成部分。针对情绪不稳定和睡眠问题的干预措施有可能降低抑郁症的风险。
