McCabe Patrick J, Christopher Paul P
Pump Handle Analytics, LLC, Corvallis, Oregon.
Department of Psychiatry & Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island.
Depress Anxiety. 2016 Feb;33(2):112-9. doi: 10.1002/da.22446. Epub 2015 Oct 16.
Despite the removal of the bereavement exclusion from DSM-5, clinicians may feel uncertain on how to proceed when caring for a patient who presents with depressive symptoms following the death of someone close. The ability to better distinguish, on a symptom and functional level, between patients who experience depression in the context of bereavement and those with nonbereavement-related depression, could help guide clinical decision making.
Individual and clustered depressive symptom and impairment measures were used for modeling bereavement status within a nationally representative longitudinal cohort. Deviance, linear shrinkage factor, and bias-corrected c-statistic were used for identifying a well-calibrated and discriminating final model.
Of the 450 (1.2%) respondents with a single brief major depressive episode, 162 (38.4%) reported the episode as bereavement-related. The bereaved were less likely to endorse worthlessness (P < .001), social conflict (P < .001), distress (P < .001), thoughts of suicide (P = .001), wanting to die (P = .01), self-medicating (P = .01), and being withdrawn (P = .04). In a multivariate model, the bereaved were more likely to have thoughts of their own death (P = .003), guilt coupled with weight or appetite loss (P = .013), and were less likely to report social conflict (P < .001), worthlessness coupled with difficulty making decisions (P < .001), thoughts of suicide (P = .006), distress coupled with weight or appetite gain (P = .022), and self-medicating (P = .045).
Traits and trait combinations differentiate individuals who experience brief depressive episodes following the death of a loved one from other brief episodes. These differences can help guide clinical care of patients who present with depressive symptoms shortly after a loved one's death.
尽管《精神疾病诊断与统计手册》第5版（DSM-5）已取消了丧亲排除标准，但临床医生在护理一位在亲近之人去世后出现抑郁症状的患者时，可能仍不确定该如何处理。在症状和功能层面上，更好地区分在丧亲情况下出现抑郁的患者与患有与丧亲无关的抑郁症患者的能力，有助于指导临床决策。
在一个具有全国代表性的纵向队列中，使用个体和聚类的抑郁症状及损害测量方法来对丧亲状态进行建模。采用偏差、线性收缩因子和偏差校正c统计量来确定一个校准良好且具有区分能力的最终模型。
在450名（1.2%）有单次短暂重度抑郁发作的受访者中，162名（38.4%）报告该发作与丧亲有关。丧亲者不太可能认可无价值感（P <.001）、社交冲突（P <.001）、痛苦（P <.001）、自杀念头（P =.001）、想死（P =.01）、自我用药（P =.01）和孤僻（P =.04）。在多变量模型中，丧亲者更有可能有自己死亡的念头（P =.003）、伴有体重或食欲下降的内疚感（P =.013），且不太可能报告社交冲突（P <.001）、伴有决策困难的无价值感（P <.001）、自杀念头（P =.006）、伴有体重或食欲增加的痛苦（P =.022）和自我用药（P =.045）。
特征及特征组合可区分在亲人去世后经历短暂抑郁发作的个体与其他短暂发作的个体。这些差异有助于指导在亲人去世后不久出现抑郁症状的患者的临床护理。
