Department of Public Health Sciences, School of Medicine, University of Connecticut, Farmington, CT, United States of America; Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, United States of America; Mental Illness Research, Education and Clinical Center of New England, US Department of Veterans Affairs Connecticut Healthcare System, West Haven, CT, United States of America.
Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, United States of America; Mental Illness Research, Education and Clinical Center of New England, US Department of Veterans Affairs Connecticut Healthcare System, West Haven, CT, United States of America.
J Affect Disord. 2021 Jan 1;278:443-452. doi: 10.1016/j.jad.2020.09.081. Epub 2020 Sep 25.
To present a three stage-model of major depressive disorder (MDD) and evaluate differences in behavioral histories/experiences and multi-morbidities between stages.
We used data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III, a nationally representative cross-sectional survey of US adults (n = 36,309). Based on DSM-5 diagnostic criteria, we identified and compared three groups of adults with MDD histories: 1) new onset MDD (n = 509; 5.6%); 2) chronic MDD (n = 3,871; 46.1%); and 3) recovered from MDD (n = 3,673; 48.3%). Multivariable analyses tested independent group differences in behavioral histories/experiences and diagnostic multi-morbidities between 1) recovered MDD vs. new onset MDD; 2) chronic MDD vs. new onset MDD; and 3) recovered MDD vs. chronic MDD.
Adults who have recovered from MDD as compared to those with chronic MDD were 2.5 times more likely to have recovered from two or more psychiatric disorders in addition to MDD (95% confidence intervals [CI]=1.76-3.61) and from alcohol use disorder (adjusted odds ratio [AOR]=1.28; 95% CI=1.08-1.52). They were also less likely than those with chronic MDD to have borderline personality disorder (p<0.001), pain (p<0.001), or medical co-morbidity (p = 0.003). Adults with new onset MDD were younger than other groups, and more likely than those who have recovered to have borderline personality disorder and concurrent psychiatric or substance use disorders (p<0.05 for all).
Behavioral histories/experiences and multi-morbidities differ significantly across stages of MDD. These concurrent problems may impede recovery and foster chronicity and should therefore be an integral focus of treatment.
提出重性抑郁障碍（MDD）的三阶段模型，并评估各阶段之间行为史/经历和多种合并症的差异。
我们使用了 2012-2013 年国家酒精相关情况和条件 III 流行病学调查的数据，这是一项对美国成年人的全国代表性横断面调查（n=36309）。根据 DSM-5 诊断标准，我们确定并比较了三组有 MDD 病史的成年人：1）新发 MDD（n=509；5.6%）；2）慢性 MDD（n=3871；46.1%）；3）MDD 缓解（n=3673；48.3%）。多变量分析检验了 1）缓解 MDD 与新发 MDD 之间；2）慢性 MDD 与新发 MDD 之间；3）缓解 MDD 与慢性 MDD 之间，行为史/经历和诊断合并症的独立组间差异。
与慢性 MDD 相比，缓解 MDD 的成年人除 MDD 之外，还有两倍以上的可能性从两种或多种精神障碍和酒精使用障碍中康复（95%置信区间[CI]=1.76-3.61）和酒精使用障碍（调整后的优势比[AOR]=1.28；95%CI=1.08-1.52）。与慢性 MDD 相比，他们也更不可能患有边缘型人格障碍（p<0.001）、疼痛（p<0.001）或合并医学疾病（p=0.003）。新发 MDD 的成年人比其他组更年轻，与缓解组相比，更有可能患有边缘型人格障碍和并发精神或物质使用障碍（p<0.05）。
MDD 各阶段之间的行为史/经历和多种合并症存在显著差异。这些并存问题可能会阻碍康复，促进慢性化，因此应成为治疗的重点。
