Koyanagi A, Oh H, Stickley A, Haro J M, DeVylder J
Research and Development Unit,Parc Sanitari Sant Joan de Déu,Universitat de Barcelona,Fundació Sant Joan de Déu,Dr Antoni Pujadas,42,Sant Boi de Llobregat,Barcelona 08830,Spain.
University of California Berkeley School of Public Health,50 University Hall #7360,Berkeley,CA 94720-7360,USA.
Psychol Med. 2016 Sep;46(12):2655-65. doi: 10.1017/S0033291716001422. Epub 2016 Jul 5.
Studies on whether the co-occurrence of psychotic experiences (PEs) and depression confers a more pronounced decrement in health status and function compared with depression alone are scarce in the general adult population.
Data on 195 479 adults aged ⩾18 years from the World Health Survey were analysed. Using the World Mental Health Survey version of the Composite International Diagnostic Interview (CIDI), depression in the past 12 months was categorized into four groups: depressive episode, brief depressive episode, subsyndromal depression, and no depression. Past 12-month psychotic symptoms were assessed using four questions on positive symptoms from the CIDI. Health status across seven domains (cognition, interpersonal activities, sleep/energy, self-care, mobility, pain/discomfort, vision) and interviewer-rated presence of a mental health problem were assessed. Multivariable logistic and linear regression analyses were performed to assess the associations.
When compared with those with no depression, individuals with depression had higher odds of reporting at least one PE, and this was seen across all levels of depression severity: subsyndromal depression [odds ratio (OR) 2.38, 95% confidence interval (CI) 2.02-2.81], brief depressive episode (OR 3.84, 95% CI 3.31-4.46) and depressive episode (OR 3.75, 95% CI 3.24-4.33). Having coexisting PEs and depression was associated with a higher risk for observable illness behavior and a significant decline in health status in the cognition, interpersonal activities and sleep/energy domains, compared with those with depression alone.
This coexistence of depression and PEs is associated with more severe social, cognitive and sleep disturbances, and more outwardly apparent illness behavior. Detecting this co-occurrence may be important for treatment planning.
在普通成年人群中，关于与单纯抑郁症相比，精神病性体验（PEs）和抑郁症同时出现是否会导致更明显的健康状况和功能下降的研究很少。
对世界卫生调查中195479名年龄≥18岁的成年人的数据进行了分析。使用世界心理健康调查版的复合国际诊断访谈（CIDI），将过去12个月的抑郁症分为四组：抑郁发作、短暂抑郁发作、亚综合征性抑郁和无抑郁症。使用CIDI中关于阳性症状的四个问题评估过去12个月的精神病性症状。评估了七个领域（认知、人际活动、睡眠/精力、自我护理、活动能力、疼痛/不适、视力）的健康状况以及访谈者评定的心理健康问题的存在情况。进行了多变量逻辑回归和线性回归分析以评估相关性。
与无抑郁症的人相比，抑郁症患者报告至少一种PEs的几率更高，并且在所有抑郁症严重程度水平上均可见：亚综合征性抑郁[比值比（OR）2.38，95%置信区间（CI）2.02 - 2.81]、短暂抑郁发作（OR 3.84，95% CI 3.31 - 4.46）和抑郁发作（OR 3.75，95% CI 3.24 - 4.33）。与单纯患有抑郁症的人相比，同时存在PEs和抑郁症与可观察到的疾病行为风险更高以及认知、人际活动和睡眠/精力领域的健康状况显著下降有关。
抑郁症和PEs的这种共存与更严重的社会、认知和睡眠障碍以及更明显的疾病行为有关。检测到这种共存情况对于治疗计划可能很重要。
