Department of Psychiatry, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, the Netherlands.
Department of Psychiatry, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, the Netherlands.
J Affect Disord. 2019 Jun 1;252:484-492. doi: 10.1016/j.jad.2019.04.052. Epub 2019 Apr 15.
The large between-person differences in symptomatology suggest that major depressive disorder (MDD) is a heterogeneous psychiatric disorder. However, symptom-specific prospective studies are scarce. We hypothesized that chronicity (i.e., being depressed for 24 months during a patient's preceding 48 months at baseline) and neuroticism at baseline would predict adverse course trajectories over 9 years of follow up with differential magnitudes for individual depressive symptoms.
In total, 560 patients with a current MDD were included from the Netherlands Study of Depression and Anxiety (NESDA-cohort). We used a multivariate linear mixed model with repeated measures, with a history of chronicity and neuroticism separately as main independent variables and with Inventory of Depressive Symptomatology self-report (IDS-SR) item scores as outcome variables. For each individual symptom, the model was adjusted for age, gender, and baseline depression severity.
Patients were on average 42.7 (SD = 12.1) years old and 64.7% were women. Patients with chronic depression or high levels of neuroticism showed similar absolute rates of decline over time compared to their counterparts. However, because symptoms had higher starting points for mood, cognitive, and somatic/vegetative symptoms (in that order), symptom severity remained higher over time. Chronicity and neuroticism were especially linked to persistent low self-esteem and high interpersonal sensitivity.
Neuroticism is partly state dependent and likely affected by depression severity.
Chronicity and neuroticism predict long-term persistence of diverse psychiatric symptoms, in particular low self-esteem and high interpersonal sensitivity.
症状之间的个体差异较大表明，重度抑郁症（MDD）是一种异质性精神障碍。然而，针对特定症状的前瞻性研究较为缺乏。我们假设，基线时的慢性（即患者在基线前的 48 个月中，有 24 个月处于抑郁状态）和神经质会预测 9 年随访期间的不良病程轨迹，并且对个体抑郁症状的预测程度不同。
共纳入了来自荷兰抑郁与焦虑研究（NESDA 队列）的 560 名当前患有 MDD 的患者。我们使用了具有重复测量的多元线性混合模型，分别将慢性和神经质病史作为主要的独立变量，将抑郁症状自评量表（IDS-SR）的项目评分作为结果变量。对于每个个体症状，模型均根据年龄、性别和基线抑郁严重程度进行了调整。
患者的平均年龄为 42.7 岁（SD=12.1），64.7%为女性。与对照组相比，慢性抑郁或高水平神经质的患者在随时间推移的绝对下降率相似。然而，由于情绪、认知和躯体/植物神经症状的起点较高（依次排列），因此症状严重程度随时间的推移仍保持较高水平。慢性和神经质与持续的低自尊和高人际敏感性尤其相关。
神经质在一定程度上是状态依赖的，并且可能受到抑郁严重程度的影响。
慢性和神经质预测了多种精神症状的长期持续存在，特别是低自尊和高人际敏感性。
