International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, Massachusetts, USA.
Department of Psychiatry, University of Padova, Padua, Italy.
Acta Psychiatr Scand. 2022 Nov;146(5):456-467. doi: 10.1111/acps.13497. Epub 2022 Sep 15.
Research findings on factors associated with onset-age (OA) with bipolar (BD) and major depressive disorders (MDD) have been inconsistent, but often indicate greater morbidity following early OA.
We considered factors associated with OA in 1033 carefully evaluated, systematically followed mood disorder subjects with DSM-5 BD (n = 505) or MDD (n = 528), comparing rates of descriptive and clinical characteristics following early (age <18), intermediate (18-40), or later onset (≥40 years), as well as regressing selected measures versus OA. Exposure time (years ill) was matched among these subgroups.
As hypothesized, many features were associated with early OA: familial psychiatric illness, including BD, greater maternal age, early sexual abuse, nondepressive first episodes, co-occurring ADHD, suicide attempts and violent suicidal behavior, abuse of alcohol or drugs, smoking, and unemployment. Other features increased consistently with later OA: %-time-depressed (in BD and MDD, women and men), as well as depressions/year and intake ratings of depression, educational levels, co-occurring medical disorders, rates of marriage and number of children.
OA averaged 7.5 years earlier in BD versus MDD (30.7 vs. 38.2). Some OA-associated measures may reflect maturation. Associations with family history and suicidal risk with earlier OA were expected; increases of time-depressed in both BD and MDD with later OA were not. We conclude that associations of OA with later morbidity are complex and not unidirectional but may be clinically useful.
有关双相情感障碍（BD）和重度抑郁症（MDD）发病年龄（OA）相关因素的研究结果一直不一致，但通常表明早期 OA 后发病率更高。
我们考虑了与 1033 名经过仔细评估、系统随访的 DSM-5 BD（n=505）或 MDD（n=528）心境障碍患者 OA 相关的因素，比较了早期（年龄<18 岁）、中期（18-40 岁）或晚期（≥40 岁）OA 后描述性和临床特征的发生率，以及针对 OA 对选定措施进行回归。这些亚组中匹配了暴露时间（患病年数）。
正如假设的那样，许多特征与早期 OA 相关：家族性精神疾病，包括 BD、母亲年龄较大、早期性虐待、非抑郁首发、共患 ADHD、自杀企图和暴力自杀行为、酒精或药物滥用、吸烟和失业。其他特征与晚期 OA 呈一致性增加：BD 和 MDD 中女性和男性的%时间抑郁、抑郁年数和抑郁摄入评分、教育水平、共患疾病、婚姻率和孩子数量。
BD 的 OA 平均比 MDD 早 7.5 年（30.7 岁比 38.2 岁）。一些与 OA 相关的措施可能反映了成熟度。与家族史和自杀风险的 OA 早期相关是预期的；BD 和 MDD 中随 OA 后时间抑郁的增加则不然。我们得出的结论是，OA 与后期发病率的关联是复杂的，不是单向的，但可能具有临床意义。
