Remmerswaal Karin C P, Ten Have Margreet, de Graaf Ron, van Balkom Anton J L M, Penninx Brenda W J H, Batelaan Neeltje M
Amsterdam UMC, location Vrije Universiteit, Department of Psychiatry, Amsterdam Public Health, Mental Health program and GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands.
Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Utrecht, The Netherlands.
Soc Psychiatry Psychiatr Epidemiol. 2024 Sep;59(9):1607-1615. doi: 10.1007/s00127-023-02591-0. Epub 2023 Nov 28.
Risk factors of a chronic course of anxiety and depressive disorders were previously studied using a limited definition of recovery, i.e. remission of the index disorder. However, frequently, other mental disorders are present at follow-up. Thus, the course of anxiety and depressive disorders was represented too rosy and the identified determinants may not apply when using a broader, more realistic definition. Additionally, physical health risk factors have often been ignored.
Data were used from two waves of the Netherlands Mental Health Survey and Incidence Study-2 including 509 respondents with 12-month anxiety disorder (panic disorder, social phobia, agoraphobia or generalized anxiety disorder) or/and major depressive disorder at baseline. Chronic course was defined as (1) presence of index disorder; and (2) presence of any anxiety, mood or substance use disorder (overall course) during the subsequent three years. Regression models were built with sociodemographic, clinical, and lifestyle/physical health indicators. Predictive accuracy was evaluated with area under the curve (AUC).
Chronic course of the index disorder was present among 24.8% of cases, whereas 38.7% had a chronic overall course. The accuracy of prediction of chronic course of the index disorder was suboptimal (AUC = 0.68) compared to prediction of overall course (AUC = 0.75). The main risk factors were baseline number of mental disorders, neuroticism, childhood abuse, parental psychopathology and alcohol use. Lifestyle and physical health indicators were marginally relevant.
Transdiagnostic risk factors are important in predicting overall course of anxiety and depressive disorders but cannot accurately predict chronic course of the index disorder.
先前对焦虑和抑郁障碍慢性病程的危险因素进行研究时，使用的康复定义较为有限，即索引障碍的缓解。然而，随访时经常会出现其他精神障碍。因此，焦虑和抑郁障碍的病程被描述得过于乐观，并且在使用更宽泛、更现实的定义时，所确定的决定因素可能并不适用。此外，身体健康危险因素常常被忽视。
使用了荷兰心理健康调查与发病率研究-2的两波数据，其中包括509名在基线时患有12个月焦虑障碍（惊恐障碍、社交恐惧症、广场恐惧症或广泛性焦虑障碍）或/和重度抑郁症的受访者。慢性病程被定义为：（1）存在索引障碍；以及（2）在随后三年中存在任何焦虑、情绪或物质使用障碍（总体病程）。构建了包含社会人口统计学、临床和生活方式/身体健康指标的回归模型。使用曲线下面积（AUC）评估预测准确性。
24.8%的病例存在索引障碍的慢性病程，而38.7%的病例有慢性总体病程。与总体病程的预测（AUC = 0.75）相比，索引障碍慢性病程的预测准确性欠佳（AUC = 0.68）。主要危险因素为基线时精神障碍的数量、神经质、童年期受虐、父母精神病理学和饮酒。生活方式和身体健康指标的相关性较小。
跨诊断危险因素在预测焦虑和抑郁障碍的总体病程方面很重要，但不能准确预测索引障碍的慢性病程。
