Zisook S, Shuchter S R, Sledge P A, Paulus M, Judd L L
Department of Psychiatry, University of California, San Diego, School of Medicine, La Jolla 92103.
J Clin Psychiatry. 1994 Apr;55 Suppl:29-36.
Major depressive syndromes have been found to be prevalent, disabling, and often persistent during the stress of bereavement. To add to the burden of mood changes associated with bereavement, a substantial number of bereaved individuals may suffer from depressive symptoms that do not quite equal the requisite number to meet criteria for a major depressive episode, but which also may be quite disabling, if not be actual forerunners of major depression. This study evaluates the frequency, morbidity, and stability of subsyndromal symptomatic depressions.
350 widows and widowers were evaluated for depressive symptoms and syndromes at 2, 13, and 25 months after the death of their spouse. An additional 126 demographically similar men and women also were evaluated. In addition to the presence of a number of depressive symptoms, a number of outcome measures were obtained: use of antidepressant medication, self-perceived physical health, satisfaction with work performance, number of days of social activity per month, self-rated adjustment to widow-hood, satisfaction with ongoing interpersonal relationships, and development of a new relationship.
Both symptomatic major depression (SMD) syndromes and subsyndromal symptomatic depression (SSD) were prevalent throughout the first 2 years of widowhood. More than one third of subjects with SSD 2 months after their spouse's death either continue to have SSD after the first full year of bereavement (28%) or worsen (9%) during that time. On most outcome measures, subjects with SSD stand between subjects with no depression and those with SMD and are significantly more likely than euthymic subjects to complain of poor physical health, be dissatisfied with their work performance, and refrain from social activity; they show a statistical trend for more disturbed ongoing relationships with friends and to be less likely to be involved in a new romantic relationship.
Although heretofore relatively unrecognized, SSDs are prevalent, often persist, and are associated with substantial morbidity in widows and widowers during the first 2 years of bereavement.
研究发现，在居丧压力期间，重度抑郁综合征普遍存在、使人致残且常常持续存在。除了与居丧相关的情绪变化负担外，相当数量的居丧者可能患有抑郁症状，这些症状虽未达到重度抑郁发作的标准所需数量，但即便不是重度抑郁的实际先兆，也可能相当使人致残。本研究评估了亚综合征症状性抑郁的频率、发病率和稳定性。
对350名丧偶者在其配偶去世后的2个月、13个月和25个月时进行抑郁症状和综合征评估。另外还对126名人口统计学特征相似的男女进行了评估。除了存在多种抑郁症状外，还获得了一些结局指标：抗抑郁药物的使用情况、自我感知的身体健康状况、对工作表现的满意度、每月社交活动天数、对丧偶生活的自我评定适应情况、对当前人际关系的满意度以及新恋情的发展情况。
在丧偶后的头两年里，症状性重度抑郁（SMD）综合征和亚综合征症状性抑郁（SSD）都很普遍。在配偶去世2个月时有SSD的受试者中，超过三分之一的人在居丧满一年后仍有SSD（28%），或在此期间病情恶化（9%）。在大多数结局指标上，有SSD的受试者介于无抑郁的受试者和有SMD的受试者之间，并且与心境正常的受试者相比，他们明显更有可能抱怨身体健康不佳、对工作表现不满意以及避免社交活动；他们在与朋友的当前关系中表现出更多困扰的统计趋势，并且不太可能卷入新的浪漫关系。
尽管迄今为止相对未得到认可，但SSD在丧偶者居丧的头两年里普遍存在，常常持续存在，并且与相当高的发病率相关。
