Virginia Institute for Psychiatric and Behavioral Genetics and Department of Psychiatry, Virginia Commonwealth University, Richmond (Kendler); Center for Primary Health Care Research, Lund University, Malmö, Sweden (Ohlsson, Jan Sundquist, Kristina Sundquist); and Department of Family Medicine and Community Health and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York (Jan Sundquist, Kristina Sundquist).
Am J Psychiatry. 2020 May 1;177(5):447-453. doi: 10.1176/appi.ajp.2019.19090911. Epub 2020 Apr 28.
The authors sought to clarify the role of rearing environment in the etiology of major depression.
Defining high risk as having at least one biological parent with major depression, the authors identified a Swedish National Sample of 666 high-risk full sibships and 2,596 high-risk half sibships containing at least one home-reared and one adopted-away sibling. Major depression was assessed from national medical registries.
Controlling for sex, parental age at birth, and, for half siblings, history of major depression in the nonshared parent, the risk for major depression in the matched adopted compared with home-reared full and half siblings was reduced by 23% (95% CI=7-36) and by 19% (95% CI=10-38), respectively. This protective rearing effect was not influenced by the relative educational status of the biological and adoptive parents. However, in both full and half sibships, the protective effect of adoption disappeared when an adoptive parent or stepsibling had major depression or the adoptive home was disrupted by parental death or divorce.
In matched full and half sibships at high risk for major depression, compared with individuals raised in their home environment, those reared in adoptive homes (homes selected in Sweden for their high-quality rearing environment) had a significantly reduced risk for major depression. This protective effect disappeared if an adoptive parent had major depression or if the adoptive home experienced parental death or divorce during childhood/adolescence. The rearing environment has a meaningful impact on risk for major depression, and this effect is likely mediated both by parental depression and the continuity or disruption of the home environment.
作者试图阐明养育环境在重度抑郁症发病机制中的作用。
将至少有一位生物学父母患有重度抑郁症定义为高危，作者确定了一个瑞典全国样本，包括 666 个高危全同胞家庭和 2596 个高危半同胞家庭，其中至少有一个是在家中抚养的，一个是被领养的。重度抑郁症是根据国家医疗记录来评估的。
在控制了性别、父母的出生年龄以及半同胞的非共享父母的重度抑郁症病史后，与在家中抚养的全同胞和半同胞相比，匹配的被领养者患重度抑郁症的风险降低了 23%（95%CI=7-36）和 19%（95%CI=10-38）。这种养育保护效应不受亲生父母和养父母相对教育程度的影响。然而，在全同胞和半同胞中，如果领养父母或继兄弟姐妹患有重度抑郁症，或者领养家庭因父母死亡或离婚而破裂，领养的保护作用就会消失。
在患有重度抑郁症的高危全同胞和半同胞中，与在家中抚养的个体相比，在领养家庭中（瑞典根据其高质量的养育环境选择的家庭）抚养的个体患重度抑郁症的风险显著降低。如果领养父母患有重度抑郁症，或者在儿童/青少年时期领养家庭经历了父母死亡或离婚，这种保护效应就会消失。养育环境对重度抑郁症的发病风险有重要影响，这种影响可能是通过父母的抑郁和家庭环境的连续性或破裂来介导的。
