Hsieh Yung-Chi, Chiu Chui-De, Chou Li-Shiu, Lin Ching-Hua, Li Dian-Jeng
Department of Adult Psychiatry, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan.
Department of Psychology, Clinical and Health Psychology Centre, and Centre for Cognition and Brain Studies, The Chinese University of Hong Kong, Hong Kong.
Psychiatry Investig. 2025 May;22(5):583-590. doi: 10.30773/pi.2024.0076. Epub 2025 May 15.
Whether dissociation and depression are distinct constructs remains controversial. The aim of this study was to explore the interrelations and associated factors between them.
This study included inpatients with major depressive disorder (MDD) and bipolar disorder with major depressive episode (BD). Clinical rating scales were used to measure levels of depression, dissociation, and psychotic symptoms. Generalized estimating equations were used to estimate interrelations between dissociation and related factors over time, including depression. Moreover, the impacts of individual items of the Hamilton Depression Rating Scale (HAMD) on dissociation were evaluated after multiple adjustments.
A total of 91 participants were included into the analysis, of whom 59 had MDD and 32 had BD. After standardized treatment, levels of depression and psychotic symptoms significantly decreased, whereas the level of dissociation did not. However, the level of dissociation significantly decreased in the high-dissociation group, and this was positively associated with the change in depression and psychotic symptoms. Female sex and comorbidity with borderline personality disorder were also positively correlated with dissociation. Among items of the HAMD, insomnia and gastrointestinal symptoms contributed to the association between depression and dissociation.
We identified a decoupled but intertwined relationship between dissociation and depression. Clinicians should be aware of this comorbidity and provide timely interventions for dissociation during clinical practice.
分离性障碍和抑郁症是否为不同的概念仍存在争议。本研究旨在探讨它们之间的相互关系及相关因素。
本研究纳入了重度抑郁症（MDD）患者和伴有重度抑郁发作的双相情感障碍（BD）患者。使用临床评定量表来测量抑郁、分离性障碍及精神病性症状的程度。采用广义估计方程来估计随时间推移分离性障碍与包括抑郁在内的相关因素之间的相互关系。此外，在进行多次校正后，评估汉密尔顿抑郁量表（HAMD）各单项对分离性障碍的影响。
共有91名参与者纳入分析，其中59例为MDD患者，32例为BD患者。经过标准化治疗后，抑郁和精神病性症状程度显著降低，而分离性障碍程度未降低。然而，高分离性障碍组的分离性障碍程度显著降低，且这与抑郁和精神病性症状的变化呈正相关。女性及合并边缘性人格障碍也与分离性障碍呈正相关。在HAMD各项目中，失眠和胃肠道症状促成了抑郁与分离性障碍之间的关联。
我们发现分离性障碍与抑郁之间存在一种既相互分离又相互交织的关系。临床医生在临床实践中应意识到这种共病情况，并及时对分离性障碍进行干预。
