Solis Ericka C, van Hemert Albert M, Carlier Ingrid V E, Wardenaar Klaas J, Schoevers Robert A, Beekman Aartjan T F, Penninx Brenda W J H, Giltay Erik J
Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands.
Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands.
J Affect Disord. 2021 Dec 1;295:1269-1279. doi: 10.1016/j.jad.2021.08.108. Epub 2021 Sep 4.
In longitudinal research, switching between diagnoses should be considered when examining patients with depression and anxiety. We investigated course trajectories of affective disorders over a nine-year period, comparing a categorical approach using diagnoses to a dimensional approach using symptom severity.
Patients with a current depressive and/or anxiety disorder at baseline (N = 1701) were selected from the Netherlands Study of Depression and Anxiety (NESDA). Using psychiatric diagnoses, we described 'consistently recovered,' 'intermittently recovered,' 'intermittently recurrent', and 'consistently chronic' at two-, four-, six-, and nine-year follow-up. Additionally, latent class growth analysis (LCGA) using depressive, anxiety, fear, and worry symptom severity scores was used to identify distinct classes.
Considering the categorical approach, 8.5% were chronic, 32.9% were intermittently recurrent, 37.6% were intermittently recovered, and 21.0% remained consistently recovered from any affective disorder at nine-year follow-up. In the dimensional approach, 66.6% were chronic, 25.9% showed partial recovery, and 7.6% had recovered.
30.6% of patients were lost to follow-up. Diagnoses were rated by the interviewer and questionnaires were completed by the participant.
Using diagnoses alone as discrete categories to describe clinical course fails to fully capture the persistence of affective symptoms that were observed when using a dimensional approach. The enduring, fluctuating presence of subthreshold affective symptoms likely predisposes patients to frequent relapse. The commonness of subthreshold symptoms and their adverse impact on long-term prognoses deserve continuous clinical attention in mental health care as well further research.
在纵向研究中，检查患有抑郁症和焦虑症的患者时应考虑诊断之间的转换。我们调查了九年间情感障碍的病程轨迹，比较了使用诊断的分类方法和使用症状严重程度的维度方法。
从荷兰抑郁症和焦虑症研究（NESDA）中选取基线时患有当前抑郁和/或焦虑症的患者（N = 1701）。使用精神科诊断，我们描述了在两年、四年、六年和九年随访时的“持续康复”、“间歇康复”、“间歇复发”和“持续慢性”情况。此外，使用抑郁、焦虑、恐惧和担忧症状严重程度评分的潜在类别增长分析（LCGA）来识别不同类别轨迹。
考虑分类方法，在九年随访时，8.5%为慢性，32.9%为间歇复发，37.6%为间歇康复，21.0%从任何情感障碍中持续康复。在维度方法中，66.6%为慢性，25.9%显示部分康复，7.6%已康复。
30.6%的患者失访。诊断由访谈者评定，问卷由参与者完成。
仅将诊断作为离散类别来描述临床病程，无法充分捕捉使用维度方法时观察到的情感症状的持续性。阈下情感症状的持续存在和波动可能使患者容易频繁复发。阈下症状的普遍性及其对长期预后的不利影响值得精神卫生保健领域持续的临床关注以及进一步研究。
