Serra Giulia, Iannoni Maria Elena, Trasolini Monia, Maglio Gino, Frattini Camilla, Casini Maria Pia, Baldessarini Ross J, Vicari Stefano
Child Neuropsychiatry Unit, Department of Neuroscience, I.R.C.C.S. Children Hospital Bambino Gesù, 00165 Rome, Italy.
International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, MA 02478, USA.
Brain Sci. 2021 Mar 29;11(4):440. doi: 10.3390/brainsci11040440.
: Severe depression is prevalent in young persons and can lead to disability and elevated suicidal risk. : To identify clinical and demographic factors associated with the severity of depression in juveniles diagnosed with a major mood disorder, as a contribution to improving clinical treatment and reducing risk of suicide. : We analyzed factors associated with depression severity in 270 juveniles (aged 6-18 years) in a major depressive episode, evaluated and treated at the Bambino Gesù Children's Hospital of Rome. Depressive symptoms were rated with the revised Children's Depression Rating Scale (CDRS-R) and manic symptoms with the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) Mania Rating Scale (K-SADS-MRS). Bivariate comparisons were followed by multivariable linear regression modeling. : Depression severity was greater among females than males (55.0 vs. 47.2), with the diagnosis of a major depressive disorder (MDD) vs. bipolar disorder (BD; 53.8 vs. 49.3), and tended to increase with age (slope = 1.14). Some symptoms typical of mania were associated with greater depression severity, including mood lability, hallucinations, delusions, and irritability, whereas less likely symptoms were hyperactivity, pressured speech, grandiosity, high energy, and distractibility. Factors independently and significantly associated with greater depression severity in multivariable linear regression modeling were: MDD vs. BD diagnosis, female sex, higher anxiety ratings, mood lability, and irritability. : Severe depression was significantly associated with female sex, the presence of some manic or psychotic symptoms, and with apparent unipolar MDD. Manic/psychotic symptoms should be assessed carefully when evaluating a juvenile depressive episode and considered in treatment planning in an effort to balance risks of antidepressants and the potential value of mood-stabilizing and antimanic agents to decrease the severity of acute episodes and reduce suicidal risk.
重度抑郁症在年轻人中很普遍，会导致残疾并增加自杀风险。为了确定与被诊断患有重度心境障碍的青少年抑郁症严重程度相关的临床和人口统计学因素，以促进改善临床治疗并降低自杀风险。我们分析了罗马的 Bambino Gesù 儿童医院评估和治疗的 270 名处于重度抑郁发作的青少年（年龄在 6 - 18 岁）中与抑郁症严重程度相关的因素。抑郁症状用修订后的儿童抑郁评定量表（CDRS - R）进行评分，躁狂症状用儿童情感障碍和精神分裂症量表（K - SADS）躁狂评定量表（K - SADS - MRS）进行评分。双变量比较之后进行多变量线性回归建模。女性的抑郁严重程度高于男性（55.0 对 47.2），被诊断为重度抑郁症（MDD）的患者比双相情感障碍（BD）患者的抑郁严重程度更高（53.8 对 49.3），并且抑郁严重程度倾向于随年龄增加（斜率 = 1.14）。一些典型的躁狂症状与更高的抑郁严重程度相关，包括情绪不稳定、幻觉、妄想和易激惹，而不太可能出现的症状是多动、言语逼迫、夸大、精力充沛和注意力分散。在多变量线性回归建模中与更高的抑郁严重程度独立且显著相关的因素是：MDD 与 BD 诊断、女性性别、更高的焦虑评分、情绪不稳定和易激惹。重度抑郁症与女性性别、一些躁狂或精神病性症状的存在以及明显单相 MDD 显著相关。在评估青少年抑郁发作时应仔细评估躁狂/精神病性症状，并在治疗计划中予以考虑，以平衡抗抑郁药的风险以及心境稳定剂和抗躁狂药物降低急性发作严重程度和降低自杀风险的潜在价值。
