Wittchen H U, Essau C A
Max Planck Institute of Psychiatry, Clinical Institute, Munich, Germany.
J Clin Psychiatry. 1993 Jan;54 Suppl:9-15.
Recent epidemiologic studies (i.e., studies conducted since 1980) have consistently demonstrated, on the basis of standardized diagnostic assessments, that there is a substantial overlap between different types of anxiety and depressive disorders. The current literature, however, discusses this issue primarily within the concept of comorbidity and there are some controversies about the existence of a separate disorder of mixed anxiety-depression (MAD). MAD can be defined by the presence of mixed symptoms of depression and anxiety that are below the diagnostic threshold for either one of these diagnoses. Since MAD has not been included in any of the current official classification systems, its prevalence, risk factors, course, and outcome have not been studied specifically in any of the recent epidemiologic studies even though MAD is thought to be very important, especially in primary care settings. This paper reviews recent epidemiologic studies and presents data from the Munich Follow-Up Study, which has found a prevalence of about 1% for MAD as defined by the ICD-10. Despite the lack of clear diagnostic criteria for MAD, there are some indications that: (1) this disorder might be frequent in primary care settings, and (2) patients with MAD frequently demonstrate subjective suffering, show impairment in personal and occupational functioning, and have high health service utilization rates. Current empirical evidence is still insufficient for deciding a suitable classificatory solution for this problem.
近期的流行病学研究（即自1980年以来开展的研究）基于标准化诊断评估一致表明，不同类型的焦虑症和抑郁症之间存在大量重叠。然而，当前文献主要在共病概念范围内讨论这一问题，对于是否存在一种单独的混合性焦虑抑郁障碍（MAD）存在一些争议。MAD可通过存在低于这两种诊断中任何一种诊断阈值的抑郁和焦虑混合症状来定义。由于MAD未被纳入任何现行官方分类系统，尽管MAD被认为非常重要，尤其是在初级保健环境中，但在近期的任何流行病学研究中都未对其患病率、危险因素、病程及转归进行专门研究。本文回顾了近期的流行病学研究，并展示了慕尼黑随访研究的数据，该研究发现按照国际疾病分类第10版（ICD - 10）定义的MAD患病率约为1%。尽管缺乏针对MAD的明确诊断标准，但有一些迹象表明：（1）这种障碍在初级保健环境中可能很常见；（2）患有MAD的患者经常表现出主观痛苦，在个人和职业功能方面存在损害，且医疗服务利用率较高。目前的实证证据仍不足以确定针对这一问题的合适分类解决方案。
