Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.
Center for Primary Health Care Research, Lund University, Malmö, Sweden.
Psychol Med. 2023 Dec;53(16):7805-7816. doi: 10.1017/S0033291723001848. Epub 2023 Jul 10.
It is clinically important to predict the conversion of major depression (MD) to bipolar disorder (BD). Therefore, we sought to identify related conversion rates and risk factors.
This cohort study included the Swedish population born from 1941 onward. Data were collected from Swedish population-based registers. Potential risk factors, including family genetic risk scores (FGRS), which were calculated based on the phenotypes of relatives in the extended family and not molecular data, and demographic/clinical characteristics from these registers were retrieved. Those with first MD registrations from 2006 were followed up until 2018. The conversion rate to BD and related risk factors were analyzed using Cox proportional hazards models. Additional analyses were performed for late converters and with stratification by sex.
The cumulative incidence of conversion was 5.84% [95% confidence interval (95% CI) 5.72-5.96] for 13 years. In the multivariable analysis, the strongest risk factors for conversion were high FGRS of BD [hazard ratio (HR) = 2.73, 95% CI 2.43-3.08], inpatient treatment settings (HR = 2.64, 95% CI 2.44-2.84), and psychotic depression (HR = 2.58, 95% CI 2.14-3.11). For late converters, the first registration of MD during the teenage years was a stronger risk factor when compared with the baseline model. When the interactions between risk factors and sex were significant, stratification by sex revealed that they were more predictive in females.
Family history of BD, inpatient treatment, and psychotic symptoms were the strongest predictors of conversion from MD to BD.
预测重度抑郁症（MD）向双相障碍（BD）的转化具有重要的临床意义。因此，我们试图确定相关的转化率和危险因素。
本队列研究纳入了自 1941 年以来出生于瑞典的人群。数据来自瑞典基于人群的登记处。收集了潜在的危险因素，包括家族遗传风险评分（FGRS），该评分是根据家族中亲属的表型计算的，而不是基于分子数据，以及这些登记处的人口统计学/临床特征。从 2006 年开始，首次出现 MD 记录的患者进行随访，直至 2018 年。使用 Cox 比例风险模型分析向 BD 的转化率和相关危险因素。还进行了晚期转化者的分析，并进行了性别分层。
13 年内，BD 的累积转化率为 5.84%（95%置信区间[95%CI] 5.72-5.96）。多变量分析中，向 BD 转化的最强危险因素是 BD 的高 FGRS（危险比[HR] = 2.73，95%CI 2.43-3.08）、住院治疗环境（HR = 2.64，95%CI 2.44-2.84）和精神病性抑郁（HR = 2.58，95%CI 2.14-3.11）。对于晚期转化者，与基线模型相比，青少年时期首次出现 MD 记录是更强的危险因素。当危险因素与性别之间的交互作用显著时，按性别分层显示，这些因素在女性中更具预测性。
BD 的家族史、住院治疗和精神病性症状是从 MD 向 BD 转化的最强预测因素。
