Judd L L, Akiskal H S, Paulus M P
Department of Psychiatry, University of California, San Diego, La Jolla 92093-0603, USA.
J Affect Disord. 1997 Aug;45(1-2):5-17; discussion 17-8. doi: 10.1016/s0165-0327(97)00055-4.
Analyses conducted in 10,526 community respondents investigated by the NIMH Epidemiological Catchment Area (ECA) Program, revealed the 1-month point prevalence of depressive symptoms and disorders in the general population, at the first ECA interview (Wave 1) to be 10%, as follows: 2.3% major depressive disorder (MDD); 2.3% dysthmic disorder (DD); 1.5% minor depressive disorder (MinD); and 3.9% subsyndromal depressive symptoms (SSD, defined as two or more depressive symptoms beneath the diagnostic threshold of MinD, DD or MDD). There appears to be two classes of SSD in this community sample: first, SSD, which occurred as an integral component of the course of unipolar major depressive disorder (MDD); and, second, SSD occurring spontaneously in non-unipolar depressed community subjects. In the first instance, SSD was frequently prodromal to episodes of MinD or MDD or residual to resolving episodes. Analyses also support the conclusion that SSD is a clinically significant, interepisode, depressive subtype of unipolar MDD, since SDD is associated with harmful dysfunction in five of six measures of adverse outcome, has a significantly increased prevalence of past histories of major depressive episodes, and an elevated lifetime prevalence of suicide attempts. Comparison of subsyndromal depressive symptomatology or depressive disorder diagnoses at Wave 1 with diagnoses obtained, 1 year later, at the Wave 2 interview, confirm the persistent and chronic nature of depression in this large representative sample of community respondents, in which 71% of subjects with depressive symptoms or disorders at Wave 1 continued to be symptomatic at Wave 2. In addition, subjects experienced a surprising degree of change in depressive symptom and disorder diagnoses during the 1-year observational window between Wave 1 and Wave 2, in which a remarkable percentage of individuals, who began the year in a depressive symptom or disorder diagnostic category, ended the year in another. This has led us to hypothesize that the typical clinical picture of unipolar MDD is dynamic and pleomorphic in nature, characterized by substantial symptomatic fluidity, in which patients frequently change diagnoses from one depressive subtype to another during their courses of illness.
美国国立精神卫生研究所（NIMH）开展的流行病学集水区（ECA）项目对10526名社区受访者进行了分析，结果显示，在首次ECA访谈（第1波）时，普通人群中抑郁症状和障碍的1个月时间患病率为10%，具体如下：重度抑郁症（MDD）为2.3%；心境恶劣障碍（DD）为2.3%；轻度抑郁症（MinD）为1.5%；亚综合征抑郁症状（SSD，定义为低于MinD、DD或MDD诊断阈值的两种或更多种抑郁症状）为3.9%。在这个社区样本中似乎存在两类SSD：第一类是作为单相重度抑郁症（MDD）病程的一个组成部分出现的SSD；第二类是在非单相抑郁社区受试者中自发出现的SSD。在第一种情况下，SSD经常是MinD或MDD发作的前驱症状，或者是发作缓解后的残留症状。分析还支持这样的结论，即SSD是单相MDD临床上一种具有重要意义的发作间期抑郁亚型，因为SDD与六项不良结局指标中的五项有害功能障碍相关，有重度抑郁发作既往史的患病率显著增加，自杀未遂的终生患病率也有所升高。将第1波时的亚综合征抑郁症状学或抑郁障碍诊断与1年后第2波访谈时获得的诊断进行比较，证实了在这个具有广泛代表性的社区受访者样本中抑郁症的持续性和慢性特征，其中第1波时有抑郁症状或障碍的受试者中，71%在第2波时仍有症状。此外，在第1波和第2波之间的1年观察期内，受试者的抑郁症状和障碍诊断出现了惊人程度的变化，其中相当大比例的个体在年初属于抑郁症状或障碍诊断类别，而在年末则属于另一个类别。这使我们推测，单相MDD的典型临床症状本质上是动态多变的，其特征是症状具有很大的流动性，患者在病程中经常从一种抑郁亚型转变为另一种抑郁亚型。
