Klerman G L, Weissman M M
Department of Psychiatry, Cornell University Medical College, Payne Whitney Psychiatric Clinic, New York, NY 10021.
JAMA. 1989 Apr 21;261(15):2229-35.
Several recent, large epidemiologic and family studies suggest important temporal changes in the rates of major depression: an increase in the rates in the cohorts born after World War II; a decrease in the age of onset with an increase in the late teenaged and early adult years; an increase between 1960 and 1975 in the rates of depression for all ages; a persistent gender effect, with the risk of depression consistently two to three times higher among women than men across all adult ages; a persistent family effect, with the risk about two to three times higher in first-degree relatives as compared with controls; and the suggestion of a narrowing of the differential risk to men and women due to a greater increase in risk of depression among young men. These trends, drawn from studies using comparable methods and modern diagnostic criteria, are evident in the United States, Sweden, Germany, Canada, and New Zealand, but not in comparable studies conducted in Korea and Puerto Rico and of Mexican-Americans living in the United States. These cohort changes cannot be fully attributed to artifacts of reporting, recall, mortality, or labeling and have implications for understanding the etiology of depression and for clinical practice.
最近的几项大型流行病学和家族研究表明，重度抑郁症的发病率出现了重要的时间变化：二战后出生的人群发病率上升；发病年龄下降，在青少年后期和成年早期有所增加；1960年至1975年间，各年龄段的抑郁症发病率均有所上升；存在持续的性别效应，在所有成年年龄段中，女性患抑郁症的风险始终比男性高两到三倍；存在持续的家族效应，一级亲属患抑郁症的风险比对照组高两到三倍；并且由于年轻男性患抑郁症的风险增加幅度更大，男女之间的风险差异有缩小的趋势。这些趋势来自使用可比方法和现代诊断标准的研究，在美国、瑞典、德国、加拿大和新西兰很明显，但在韩国、波多黎各以及在美国生活的墨西哥裔美国人中进行的可比研究中却不明显。这些队列变化不能完全归因于报告、回忆、死亡率或标签的人为因素，对理解抑郁症的病因和临床实践具有重要意义。
