Brown G W, Harris T O, Eales M J
Royal Holloway, University of London, UK.
Br J Psychiatry Suppl. 1996 Jun(30):50-7.
Differences in rates of depression across and between populations can be considerable and are largely determined by psychosocial factors. Such findings have important implications for comorbidity. On the basis of multiplying independent probabilities, the proportion of comorbid conditions increases as base rates of the disorders increase in a population. If such a chance combination has clinical implications, it would appear to be a "fact" of significance irrespective of biological underpinnings. In a recent survey of 404 women living with at least one child in an inner-city area, the rate of both anxiety and depression was highly related to the childhood experiences of neglect and abuse. However, adversity in adult life (e.g. widowhood or divorce), which might be expected to relate to current stressors, was only related to the rate of depression. The two risk factors had a considerable impact on comorbidity by increasing the rate of each disorder and thus the probability of their occurring together. They had a lesser impact as "common antecedents". If both influences are considered, such adversity explains around half of the comorbidity. This is a conservative estimate of the impact of psychosocial factors.
不同人群之间以及人群内部抑郁症发病率的差异可能相当大，并且在很大程度上由社会心理因素决定。这些发现对共病现象具有重要意义。基于独立概率相乘的原理，随着人群中疾病的基础发病率增加，共病情况的比例也会上升。如果这样的偶然组合具有临床意义，那么无论其生物学基础如何，这似乎都是一个具有重要意义的“事实”。在最近一项对404名居住在市中心区且至少育有一个孩子的女性的调查中，焦虑症和抑郁症的发病率都与童年时期遭受忽视和虐待的经历高度相关。然而，成年生活中的逆境（如丧偶或离婚），本以为会与当前的压力源相关，但实际上仅与抑郁症的发病率有关。这两个风险因素通过提高每种疾病的发病率，进而增加它们同时出现的概率，对共病产生了相当大的影响。作为“共同的先决条件”，它们的影响较小。如果同时考虑这两种影响因素，这种逆境大约解释了一半的共病情况。这是对社会心理因素影响的一个保守估计。
