Kendler K S, Neale M C, Kessler R C, Heath A C, Eaves L J
Department of Psychiatry, Medical College of Virginia/Virginia Commonwealth University, Richmond.
Arch Gen Psychiatry. 1993 Nov;50(11):863-70. doi: 10.1001/archpsyc.1993.01820230054003.
In epidemiologic samples, the assessment of lifetime history (LTH) of major depression (MD) is not highly reliable. In female twins, we previously found that LTH of MD, as assessed at a single personal interview, was moderately heritable (approximately 40%). In that analysis, errors of measurement could not be discriminated from true environmental effects.
In 1721 female twins from a population-based register, including both members of 742 pairs, LTH of MD, covering approximately the same time period, was obtained twice, once by self-administered questionnaire and once at personal interview.
Reliability of LTH of MD was modest (kappa = +.34, tetrachoric r = +.56) and was predicted by the number of depressive symptoms, treatment seeking, number of episodes, and degree of impairment. Deriving an "index of caseness" from these predictors, the estimated heritability of LTH of MD was greater for more restrictive definitions. Incorporating error of measurement into a structural equation model including both occasions of measurement, the estimated heritability of the liability to LTH of MD increased substantially (approximately 70%). More than half of what was considered environmental effects when LTH of MD was analyzed on the basis of one assessment appeared, when two assessments were used, to reflect measurement error.
Major depression, as assessed over the lifetime, may be a rather highly heritable disorder of moderate reliability rather than a moderately heritable disorder of high reliability.
在流行病学样本中，对重度抑郁症（MD）终生病史（LTH）的评估并非高度可靠。在女性双胞胎中，我们之前发现，通过单次个人访谈评估的MD终生病史具有中度遗传性（约40%）。在该分析中，测量误差无法与真正的环境影响区分开来。
在一个基于人群登记的1721名女性双胞胎中，包括742对双胞胎的双方，在大致相同的时间段内，通过自我填写问卷和个人访谈两次获得MD的终生病史。
MD终生病史的可靠性一般（卡帕系数=+.34，四分相关系数=+.56），并可通过抑郁症状数量、寻求治疗情况、发作次数和损害程度进行预测。根据这些预测因素得出一个“病例指数”，对于更严格的定义，MD终生病史的估计遗传度更高。将测量误差纳入包含两次测量情况的结构方程模型中，MD终生病史易感性的估计遗传度大幅增加（约70%）。当基于一次评估分析MD终生病史时，超过一半被认为是环境影响的因素，在使用两次评估时，似乎反映的是测量误差。
终生评估的重度抑郁症可能是一种遗传度相当高但可靠性一般的疾病，而非遗传度一般但可靠性高的疾病。
