Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
J Affect Disord. 2018 Dec 1;241:206-215. doi: 10.1016/j.jad.2018.08.010. Epub 2018 Aug 9.
Information on the natural course of subthreshold depression and risk factors for the development of a full-blown depressive disorder in the general population is scarce. This information is crucial to understand the development of depression and to advance indicated depression prevention.
Using longitudinal data from a representative population-based study (the Netherlands Mental Health Survey and Incidence Study-2) we assessed 3-year course of subthreshold depression (depressive symptoms causing clinically significant distress for at least 2 weeks, or for 3 days per month for a year; n = 120), compared to an asymptomatic group (n = 4111) and a depressive disorder group (major depression or dysthymia; n = 294). Next, risk factors for the development of a depressive disorder among adults with subthreshold depression were determined.
Twelve percent of the subthreshold cases developed a full-blown depressive disorder during 3-year follow-up. Risk factors were lower social support, having recurrent short episodes of depressive symptomatology, remitted and current anxiety disorder, remitted substance use disorder, lifetime suicide thoughts, a chronic physical disorder and diminished mental and physical functioning.
The number of subjects with subthreshold depression that developed a depressive disorder was small. This limits the possibility to detect significant risk factors.
Only a minority of the subthreshold cases developed a full-blown depressive disorder over three years. This shows that subthreshold depression does not, by itself, carry an a priori risk to warrant focusing indicated prevention. The identified risk factors could help to detect those subthreshold cases in whom depression prevention is economically and practically viable.
关于亚临床抑郁症的自然病程以及一般人群中发展为重度抑郁症的风险因素的信息很少。这些信息对于了解抑郁症的发展和推进有针对性的抑郁症预防至关重要。
我们使用来自代表性人群的纵向数据（荷兰精神健康调查和发病率研究-2），评估了亚临床抑郁症（抑郁症状至少持续 2 周，或每月 3 天，持续 1 年，引起明显的痛苦；n=120）的 3 年病程，将其与无症状组（n=4111）和抑郁症组（重度抑郁症或心境恶劣障碍；n=294）进行比较。接下来，确定亚临床抑郁症患者发展为抑郁症的风险因素。
12%的亚临床病例在 3 年随访期间发展为重度抑郁症。风险因素包括社会支持较低、反复出现短暂的抑郁症状、缓解和当前的焦虑症、缓解的物质使用障碍、终生自杀念头、慢性身体疾病以及心理和身体功能下降。
发展为抑郁症的亚临床病例数量较少。这限制了发现显著风险因素的可能性。
只有少数亚临床病例在三年内发展为重度抑郁症。这表明亚临床抑郁症本身并不构成有针对性预防的先决风险。确定的风险因素可以帮助发现那些在经济和实践上可行的进行抑郁症预防的亚临床病例。
