University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands.
Department of Psychological Methods, University of Amsterdam, Amsterdam, the Netherlands; Centre for Urban Mental Health, University of Amsterdam, Amsterdam, the Netherlands.
J Affect Disord. 2021 Nov 1;294:227-234. doi: 10.1016/j.jad.2021.07.002. Epub 2021 Jul 8.
Major depression (MD) is a heterogeneous disorder in terms of its symptoms. Symptoms vary by presence of risk factors such as female sex, familial risk, and environmental adversity. However, it is unclear if these factors also influence interactions between symptoms. This study investigates if symptom networks diverge across sex, familial risk, and adversity.
We included 9713 subjects from the general population who reported a lifetime episode of MD based on DSM-IV criteria. The survey assessed a wide set of symptoms, both from within the DSM criteria as well as other symptoms commonly experienced in MD. We compared symptom endorsement rates across sex, age at onset, family history and environmental adversity. We used the Network Comparison Test to test for symptom network differences across risk factors.
We found differences in symptom endorsement between groups. For instance, participants with an early onset of MD reported suicidal ideation nearly twice as often compared to participants with a later onset. We did not find any robust differences in symptom networks, which suggests that symptom networks do not diverge across sex, familial risk, and adversity.
We estimated symptom networks of individuals during their worst lifetime episode of MD. Network differences might exist in a prodromal stage, while disappearing in full-blown MD (equifinality). Furthermore, as we used retrospective reports, results could be prone to recall bias.
Despite MD's heterogeneous symptomatology, interactions between symptoms are stable across risk factors and sex.
重度抑郁症（MD）在症状方面存在异质性。症状因危险因素的存在而有所不同，例如女性、家族风险和环境逆境。然而，这些因素是否也会影响症状之间的相互作用尚不清楚。本研究旨在探讨症状网络是否会因性别、家族风险和逆境而发生变化。
我们纳入了 9713 名来自普通人群的受试者，他们根据 DSM-IV 标准报告了一生中发生的 MD 发作。该调查评估了广泛的症状，包括 DSM 标准内的症状以及 MD 中常见的其他症状。我们比较了性别、发病年龄、家族史和环境逆境对症状表达率的影响。我们使用网络比较检验来检验危险因素之间的症状网络差异。
我们发现不同组别之间的症状表达存在差异。例如，与发病较晚的患者相比，发病较早的 MD 患者报告自杀意念的频率几乎高出一倍。我们没有发现症状网络有任何明显的差异，这表明症状网络不会因性别、家族风险和逆境而发生变化。
我们在个体最严重的一生中发作 MD 期间估计了症状网络。在前驱阶段可能存在症状网络差异，而在全面发作的 MD 中可能消失（等价性）。此外，由于我们使用了回顾性报告，结果可能容易受到回忆偏差的影响。
尽管 MD 的症状表现具有异质性，但症状之间的相互作用在危险因素和性别之间是稳定的。
