Rosenström Tom, Fawcett Tim W, Higginson Andrew D, Metsä-Simola Niina, Hagen Edward H, Houston Alasdair I, Martikainen Pekka
School of Biological Sciences, University of Bristol, Bristol, United Kingdom.
Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
PLoS One. 2017 Jun 14;12(6):e0179495. doi: 10.1371/journal.pone.0179495. eCollection 2017.
Divorce is associated with an increased probability of a depressive episode, but the causation of events remains unclear. Adaptive models of depression propose that depression is a social strategy in part, whereas non-adaptive models tend to propose a diathesis-stress mechanism. We compare an adaptive evolutionary model of depression to three alternative non-adaptive models with respect to their ability to explain the temporal pattern of depression around the time of divorce. Register-based data (304,112 individuals drawn from a random sample of 11% of Finnish people) on antidepressant purchases is used as a proxy for depression. This proxy affords an unprecedented temporal resolution (a 3-monthly prevalence estimates over 10 years) without any bias from non-compliance, and it can be linked with underlying episodes via a statistical model. The evolutionary-adaptation model (all time periods with risk of divorce are depressogenic) was the best quantitative description of the data. The non-adaptive stress-relief model (period before divorce is depressogenic and period afterwards is not) provided the second best quantitative description of the data. The peak-stress model (periods before and after divorce can be depressogenic) fit the data less well, and the stress-induction model (period following divorce is depressogenic and the preceding period is not) did not fit the data at all. The evolutionary model was the most detailed mechanistic description of the divorce-depression link among the models, and the best fit in terms of predicted curvature; thus, it offers most rigorous hypotheses for further study. The stress-relief model also fit very well and was the best model in a sensitivity analysis, encouraging development of more mechanistic models for that hypothesis.
离婚与抑郁发作概率增加有关，但事件的因果关系仍不明确。抑郁症的适应性模型认为，抑郁症在一定程度上是一种社会策略，而非适应性模型则倾向于提出素质-应激机制。我们将抑郁症的适应性进化模型与三种替代性非适应性模型进行比较，看它们解释离婚前后抑郁症时间模式的能力如何。以抗抑郁药物购买记录为基础的数据（从11%的芬兰人随机样本中抽取的304,112人）被用作抑郁症的替代指标。该替代指标提供了前所未有的时间分辨率（10年期间每三个月的患病率估计），且不存在任何因不依从导致的偏差，并且可以通过统计模型与潜在发作情况相联系。进化适应模型（所有有离婚风险的时间段都具有致抑郁性）是对数据的最佳定量描述。非适应性应激缓解模型（离婚前的时间段具有致抑郁性，离婚后的时间段则不然）对数据的定量描述次之。峰值应激模型（离婚前后的时间段都可能具有致抑郁性）对数据的拟合度较差，而应激诱导模型（离婚后的时间段具有致抑郁性，之前的时间段则不然）根本无法拟合数据。在这些模型中，进化模型是对离婚与抑郁之间联系最详细的机制描述，在预测曲率方面拟合度最佳；因此，它为进一步研究提供了最严谨的假设。应激缓解模型的拟合度也非常好，并且在敏感性分析中是最佳模型，这促使为该假设开发更具机制性的模型。
