Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands.
Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands.
J Affect Disord. 2022 Nov 15;317:149-155. doi: 10.1016/j.jad.2022.08.083. Epub 2022 Aug 27.
Existing studies on disease course usually apply relatively short follow-up periods and narrow definitions of disease course resulting in too optimistic views on disease prognosis. This study explores the relevance of using a longer and broader (cross-disorder) perspective.
Respondents with a 12-month disorder at baseline and available at 3-, 6- and 9-year follow-up were selected (major depressive disorder, MDD: n = 208; anxiety disorder: n = 220) from a general population study (N = 6646). DSM-IV disorders were assessed with the Composite International Diagnostic Interview. Disease course was described using a short and narrow perspective (i.e., 3-year follow-up, and considering presence of the index disorder only) and a long and broad perspective (9-year follow-up, and considering presence of any mood, anxiety or substance use disorder as outcome).
The recovery rates of both MDD and anxiety disorder reduced by half when the perspective switched from short and narrow (MDD: 74.0 %; anxiety disorder: 79.5 %) to long and broad (35.6 % and 40.0 % respectively). At 9-year follow-up, the rates of a persistent disorder (a disorder at each follow-up assessment) tripled when the perspective switched from narrow to broad (MDD: from 4.8 % to 13.9 %; anxiety disorder: from 4.5 % to 15.5 %).
The findings are not generalizable to the most severe depressed and anxious patients.
Most people with MDD or anxiety disorder in the general population have a rather favourable prognosis when a narrow perspective is applied, but an unfavourable prognosis when a long-term and broad perspective is applied. Consequently, MDD and anxiety disorder should not merely be perceived as episodic disorders, and require longer-term disease monitoring and management.
现有关于疾病过程的研究通常采用相对较短的随访期和较窄的疾病过程定义，从而对疾病预后过于乐观。本研究探讨了采用较长和较宽（跨疾病）视角的相关性。
从一项一般人群研究（N=6646）中选择基线时有 12 个月疾病且可在 3、6 和 9 年随访时获得的患者（重性抑郁障碍，MDD：n=208；焦虑障碍：n=220）。使用复合国际诊断访谈评估 DSM-IV 障碍。使用短期和狭义视角（即 3 年随访，仅考虑指数障碍的存在）和长期和广义视角（9 年随访，将任何心境、焦虑或物质使用障碍作为结果）描述疾病过程。
当视角从短期和狭义（MDD：74.0%；焦虑障碍：79.5%）切换到长期和广义（分别为 35.6%和 40.0%）时，MDD 和焦虑障碍的恢复率减半。在 9 年随访时，当视角从狭义切换到广义时，持续性疾病（每个随访评估的疾病）的比率增加了两倍（MDD：从 4.8%增加到 13.9%；焦虑障碍：从 4.5%增加到 15.5%）。
这些发现不适用于最严重的抑郁和焦虑患者。
当采用狭义视角时，大多数普通人群中的 MDD 或焦虑障碍患者的预后相当有利，但当采用长期和广义视角时，预后不佳。因此，MDD 和焦虑障碍不应仅仅被视为发作性疾病，需要进行更长期的疾病监测和管理。
