Meisenzahl Eva, Schultze-Lutter Frauke, Stegmüller Veronika, Schulte-Körne Gerd, Greimel Ellen, Klingele Cosima, Dannlowski Udo, Hahn Tim, Romer Georg, Romanos Marcel, Deserno Lorenz, Theisen Christian, Kujovic Milenko, Ruhrmann Stefan, Forstner Andreas J, Wege Natalia
Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.
Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany.
Front Psychiatry. 2024 Sep 30;15:1389370. doi: 10.3389/fpsyt.2024.1389370. eCollection 2024.
Early recognition and indicated prevention is a promising approach to decrease the incidence of Major depressive episodes (MDE), targeting the patients during their clinical high-risk state of MDE (CHR-D). The identification of a set of stressors at the CHR-D increases the success of indicated prevention with personalized early interventions. The study evaluated stressors in the early phase of depression, developed on the basis of a patient survey on stressors.
Sixty-eight inpatients (ICD10: F3x.xx) with a reported high risk state for major depressive episode (CHR-D) were included in the current study. Stressors during CHR-D were retrospectively explored using a semi-structured clinical interview supplemented by open-ended questions. A qualitative explorative content analysis was provided to identify a pattern of stressors during the prodromal phase of the patients, based on the patient's perspective. A frequency analysis was performed for the evaluation of the prevalence of reported source of stress.
All patients reported stressors in the prodromal phase of depression. Results demonstrates that patients with depressive disorder typically report multiple stressors, with the most common number being four. First, 18 stressors-groups were identified during coding. Interpersonal conflicts and disappointments in close relationships were most frequently reported stressors during the prodromal phase at 44.1%. The second most frequent stressor mentioned was the high qualitative or quantitative demands at work (38.2%). The third frequent source of stress was changes in close relationships and in family relationships (33.8%). Based on the categories of stressors described in the patient survey during the prodromal phase we suggested a model of stressors in CHR-D during the prodromal phase of the MDE.
The identification of a set of stressors at the early stage of MDE may increase opportunities for early intervention. In everyday clinical practice, preventive psychiatry needs clinical and adapted instruments for recording stressors in today's society. This knowledge is necessary in order to develop precisely indicated prevention for depressive disorders.
早期识别和针对性预防是一种很有前景的降低重度抑郁发作（MDE）发病率的方法，其目标是处于MDE临床高危状态（CHR-D）的患者。识别CHR-D阶段的一系列应激源可提高通过个性化早期干预进行针对性预防的成功率。该研究基于一项关于应激源的患者调查，评估了抑郁早期阶段的应激源。
本研究纳入了68名报告有重度抑郁发作高危状态（CHR-D）的住院患者（ICD10：F3x.xx）。通过半结构化临床访谈并辅以开放式问题，对CHR-D期间的应激源进行回顾性探究。基于患者视角，进行定性探索性内容分析以确定患者前驱期应激源的模式。进行频率分析以评估所报告应激源的流行程度。
所有患者均报告在抑郁前驱期存在应激源。结果表明，患有抑郁症的患者通常报告多个应激源，最常见的数量为4个。首先，编码期间确定了18个应激源组。人际关系冲突和亲密关系中的失望是前驱期最常报告的应激源，占44.1%。提及的第二常见应激源是工作中的高质性或定量要求（38.2%）。第三常见的应激源是亲密关系和家庭关系的变化（33.8%）。基于患者调查中在前驱期描述的应激源类别，我们提出了MDE前驱期CHR-D阶段的应激源模型。
识别MDE早期阶段的一系列应激源可能会增加早期干预的机会。在日常临床实践中，预防性精神病学需要临床适用的工具来记录当今社会的应激源。为了针对抑郁症开展精确的针对性预防，这些知识是必要的。
