探究共病抑郁和焦虑的本质：比较诊断性和维度性研究方法。
Investigating the nature of co-occurring depression and anxiety: Comparing diagnostic and dimensional research approaches.
作者信息
Kircanski Katharina, LeMoult Joelle, Ordaz Sarah, Gotlib Ian H
机构信息
Department of Psychology, Stanford University, United States.
Department of Psychology, Stanford University, United States.
出版信息
J Affect Disord. 2017 Jul;216:123-135. doi: 10.1016/j.jad.2016.08.006. Epub 2016 Aug 13.
BACKGROUND
Although approximately half of adults diagnosed with a depressive or anxiety disorder exhibit their simultaneous co-occurrence, traditional research has centered on single-target diagnoses, overlooking comorbidities within samples. In this article, we review and extend the literature that directly investigates co-occurring depression and anxiety, with the goal of shifting the focus from co-occurring diagnoses to symptom dimensions.
METHODS
First, we review studies that have directly compared psychobiological features (neural, neuroendocrine, autonomic) across depression, anxiety, and their co-occurrence, defined either categorically or dimensionally. Second, we analyze adults' diurnal cortisol secretion to examine the independent and interactive relations of continuously-assessed depressive and anxiety symptoms to neuroendocrine function.
RESULTS
Previous findings on the psychobiology of diagnostic co-occurrence are mixed. While nascent, evidence from dimensionally focused studies suggests that co-occurring levels of depressive and anxiety symptoms can interact with one another, as reflected in a distinct psychobiological profile for individuals with high levels of both symptom dimensions. Results of our analyses support this formulation: we found that depressive and anxiety symptom dimensions interacted consistently in their relation to the measures of diurnal cortisol.
LIMITATIONS
The illustrative sample was relatively small and included only women; future research should examine generalizability of these findings.
CONCLUSIONS
A dimensional approach to investigating the psychobiology of co-occurring depression and anxiety affords both conceptual and practical advantages. Simultaneously assessing depressive and anxiety symptom dimensions can efficiently capture their unique, shared, and interactive features, thereby identifying targets for intervention across a wide range of symptom presentations.
背景
尽管约半数被诊断患有抑郁症或焦虑症的成年人表现出这两种疾病同时存在，但传统研究一直以单一目标诊断为中心，忽视了样本中的共病情况。在本文中，我们回顾并拓展了直接研究抑郁症和焦虑症共病情况的文献，目的是将研究重点从共病诊断转移到症状维度。
方法
首先，我们回顾了直接比较抑郁症、焦虑症及其共病情况下心理生物学特征（神经、神经内分泌、自主神经）的研究，这些特征按类别或维度进行定义。其次，我们分析成年人的昼夜皮质醇分泌情况，以研究持续评估的抑郁和焦虑症状与神经内分泌功能之间的独立关系和交互关系。
结果
先前关于诊断共病心理生物学的研究结果不一。虽然基于维度的研究刚刚起步，但证据表明，抑郁和焦虑症状的共病水平可能会相互作用，这体现在两种症状维度得分都很高的个体具有独特的心理生物学特征。我们的分析结果支持这一观点：我们发现抑郁和焦虑症状维度在与昼夜皮质醇测量值的关系上始终存在相互作用。
局限性
说明性样本相对较小且仅包括女性；未来的研究应检验这些发现的普遍性。
结论
采用维度方法研究抑郁症和焦虑症共病的心理生物学具有概念和实践上的优势。同时评估抑郁和焦虑症状维度能够有效捕捉它们的独特、共同和交互特征，从而确定针对广泛症状表现的干预目标。
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