Department of Psychology, Tsinghua University, Beijing, China.
Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, USA.
Psychol Med. 2023 Apr;53(6):2352-2360. doi: 10.1017/S0033291721004190. Epub 2021 Nov 22.
Risk factors for depressive disorders (DD) change substantially over time, but the prognostic value of these changes remains unclear. Two basic types of dynamic effects are possible. The 'Risk Escalation hypothesis' posits that worsening of risk levels predicts DD onset above average level of risk factors. Alternatively, the 'Chronic Risk hypothesis' posits that the average level rather than change predicts first-onset DD.
We utilized data from the ADEPT project, a cohort of 496 girls (baseline age 13.5-15.5 years) from the community followed for 3 years. Participants underwent five waves of assessments for risk factors and diagnostic interviews for DD. For illustration purposes, we selected 16 well-established dynamic risk factors for adolescent depression, such as depressive and anxiety symptoms, personality traits, clinical traits, and social risk factors. We conducted Cox regression analyses with time-varying covariates to predict first DD onset.
Consistently elevated risk factors (i.e. the mean of multiple waves), but not recent escalation, predicted first-onset DD, consistent with the Chronic Risk hypothesis. This hypothesis was supported across all 16 risk factors.
Across a range of risk factors, girls who had first-onset DD generally did not experience a sharp increase in risk level shortly before the onset of disorder; rather, for years before onset, they exhibited elevated levels of risk. Our findings suggest that chronicity of risk should be a particular focus in screening high-risk populations to prevent the onset of DDs. In particular, regular monitoring of risk factors in school settings is highly informative.
抑郁障碍（DD）的风险因素随时间发生显著变化，但这些变化的预后价值仍不清楚。有两种基本类型的动态效应是可能的。“风险升级假说”认为，风险水平的恶化预示着平均风险因素水平以上的 DD 发作。或者，“慢性风险假说”认为，平均水平而不是变化预测首次发作的 DD。
我们利用了 ADEPT 项目的数据，该项目是一个来自社区的 496 名女孩（基线年龄 13.5-15.5 岁）的队列，随访了 3 年。参与者接受了五次风险因素评估和 DD 诊断访谈。为了说明问题，我们选择了 16 个经过充分验证的青少年抑郁动态风险因素，如抑郁和焦虑症状、人格特质、临床特征和社会风险因素。我们进行了 Cox 回归分析，其中包括随时间变化的协变量，以预测首次 DD 发作。
一致升高的风险因素（即多次波的平均值），而不是最近的升级，预测了首次发作的 DD，这与慢性风险假说一致。该假说得到了所有 16 个风险因素的支持。
在一系列风险因素中，首次发作 DD 的女孩通常在发病前不久并没有经历风险水平的急剧增加；相反，在发病前的多年里，她们表现出较高的风险水平。我们的研究结果表明，风险的慢性应成为筛查高危人群以预防 DD 发作的一个特别重点。特别是，在学校环境中定期监测风险因素是非常有意义的。
