King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, UK.
Division of Global Mental Health, Department of Psychiatry, School of Medicine and Health Sciences, The George Washington University, 2120 L St NW, Ste 600, Washington DC, 20037, USA.
J Psychiatr Res. 2021 Jun;138:163-175. doi: 10.1016/j.jpsychires.2021.04.003. Epub 2021 Apr 7.
Although the aetiology and pathophysiology of depression are multifactorial, to date most studies have examined either biological or environmental mechanisms without looking at the integration of both; with most studies conducted in high-income countries (HICs). Therefore, we conducted a systematic review of worldwide studies investigating the relationship between biological and environmental stress risk factors for major depressive disorder (MDD) in adolescence.
We searched MEDLINE (via Ovid), PsycINFO, Cochrane Database of Systematic Reviews, Web of Science (Core Collection), Lilacs, African Journals Online and Global Health for prospective and cross-sectional studies that examined the association between biological markers and environmental stress risk factors in MDD during adolescence.
Of 11,089 articles identified, 21 were included, with only two from middle-income countries. Increased inflammation, telomere length and brain abnormalities, including blunted reward-related activity, white matter disruptions, and altered volume of limbic brain regions, were associated with increased risk for MDD mainly in the context of early life adversity. There is little evidence suggesting that the neurobiological changes investigated were associated with MDD in the context of recent life stress.
The developmental trajectory of depression appears to start with early life adversities and occurs in the context of immune and brain abnormalities. Understanding these biopsychosocial processes will help to improve our ability to detect individuals at risk of developing depression in adolescence. However, generalizability is limited by few studies examining both biological and environmental stress risk factors and a lack of studies on adolescents and young adults in low-and-middle-income countries (LMICs).
尽管抑郁症的病因和发病机制是多因素的，但迄今为止，大多数研究都只关注了生物学或环境机制，而没有考虑两者的整合；而且大多数研究都是在高收入国家（HICs）进行的。因此，我们对全世界研究青少年时期重度抑郁症（MDD）的生物学和环境应激风险因素之间关系的研究进行了系统回顾。
我们在 MEDLINE（通过 Ovid）、PsycINFO、Cochrane 系统评价数据库、Web of Science（核心合集）、Lilacs、African Journals Online 和 Global Health 中搜索了前瞻性和横断面研究，这些研究调查了青少年时期 MDD 中生物学标志物与环境应激风险因素之间的关联。
在确定的 11089 篇文章中，有 21 篇被纳入，其中只有 2 篇来自中等收入国家。炎症、端粒长度和大脑异常的增加，包括奖赏相关活动减弱、白质中断以及边缘脑区体积改变，与 MDD 的风险增加有关，主要是在早期生活逆境的背景下。几乎没有证据表明所调查的神经生物学变化与近期生活压力背景下的 MDD 有关。
抑郁症的发展轨迹似乎始于生命早期的逆境，发生在免疫和大脑异常的背景下。了解这些生物心理社会过程将有助于提高我们在青少年时期发现有发展为抑郁症风险的个体的能力。然而，由于很少有研究同时检查生物学和环境应激风险因素，而且在中低收入国家（LMICs）中，也缺乏对青少年和年轻成年人的研究，因此可推广性受到限制。
