Sherbourne C D, Wells K B, Hays R D, Rogers W, Burnam M A, Judd L L
RAND, Santa Monica, CA 90407-2138.
Am J Psychiatry. 1994 Dec;151(12):1777-84. doi: 10.1176/ajp.151.12.1777.
The authors examined the clinical significance of depressive symptoms below the threshold for depressive disorder in outpatient samples.
The subjects were 775 adult patients with current depressive disorder, 1,420 patients with subthreshold depression, and 1,767 hypertensive patients with and without depression, all of whom were visiting the offices of mental health specialists and general medical care providers in three U.S. cities. Data on demographic characteristics, severity of depression, extent of psychiatric and medical comorbidity, family psychiatric history, and treatment history for the patients with depressive disorder and those with subthreshold depression were compared.
The percentage of patients with subthreshold depression who had a family history of depression (41%) was nearly as high as that of the patients with depressive disorder (59%). The two groups of patients had similar levels of medical and psychiatric comorbidity except for anxiety disorders, which were greater among the patients with depressive disorder. Among the hypertensive patients in the general medical sector, those with subthreshold depression were more similar to those with depressive disorder than to the nondepressed hypertensive patients. Treatment rates were considerably lower for patients with subthreshold depression than for patients with depressive disorder in the general medical sector, but they were similar in the mental health specialty sector.
In these outpatients, subthreshold depression appeared to be a variant of affective disorder and was treated as such in the mental health specialty sector but not in the general medical sector. The findings emphasize the importance of treatment outcome studies of patients with subthreshold depression.
作者研究了门诊样本中低于抑郁症阈值的抑郁症状的临床意义。
受试者包括775名患有当前抑郁症的成年患者、1420名患有阈下抑郁症的患者以及1767名有或无抑郁症的高血压患者，他们均前往美国三个城市的心理健康专家和普通医疗服务提供者的办公室就诊。对抑郁症患者和阈下抑郁症患者的人口统计学特征、抑郁严重程度、精神和躯体共病程度、家族精神病史以及治疗史数据进行了比较。
有抑郁症家族史的阈下抑郁症患者比例（41%）几乎与抑郁症患者（59%）一样高。除焦虑症在抑郁症患者中更为常见外，两组患者的躯体和精神共病水平相似。在普通医疗部门的高血压患者中，阈下抑郁症患者与抑郁症患者更为相似，而非与无抑郁症的高血压患者相似。在普通医疗部门，阈下抑郁症患者的治疗率远低于抑郁症患者，但在心理健康专科部门两者相似。
在这些门诊患者中，阈下抑郁症似乎是情感障碍的一种变体，在心理健康专科部门如此看待并进行治疗，但在普通医疗部门并非如此。研究结果强调了阈下抑郁症患者治疗结果研究的重要性。
