Kessler R C, Zhao S, Blazer D G, Swartz M
Department of Health Care Policy, Harvard Medical School, Boston, MA 02114, USA.
J Affect Disord. 1997 Aug;45(1-2):19-30. doi: 10.1016/s0165-0327(97)00056-6.
Data from the National Comorbidity Survey are used to study the lifetime prevalences, correlates, course and impairments associated with minor depression (mD), major depression 5-6 symptoms (MD 5-6), and major depression with seven or more symptoms (MD 7-9) in an effort to determine whether mD is on a continuum with MD. There is a monotonic increase in average number of episodes, average length of longest episode, impairment, comorbidity, and parental history of psychiatric disorders as we go from mD to Md 5-6 to MD 7-9. In most of these cases, though, the differences between mD and MD 5-6 are no longer than the differences between MD 5-6 and MD 7-9, arguing for continuity between mD and MD. Coupled with the finding from earlier studies that subclinical depression is a significant risk factor for major depression, these results argue that minor depression is a variant of depressive disorder that should be considered seriously both as a target for preventive intervention and for treatment. The paper closes with suggestions regarding the analysis of mD subtypes in future longitudinal studies.
来自全国共病调查的数据被用于研究轻度抑郁(mD)、有5 - 6个症状的重度抑郁(MD 5 - 6)和有7个或更多症状的重度抑郁(MD 7 - 9)的终生患病率、相关因素、病程及损害,以确定轻度抑郁是否与重度抑郁处于一个连续体上。当我们从轻度抑郁到重度抑郁5 - 6个症状再到重度抑郁7 - 9个症状时,发作的平均次数、最长发作的平均时长、损害、共病情况以及精神疾病的家族史都呈单调增加。然而,在大多数情况下,轻度抑郁与重度抑郁5 - 6个症状之间的差异并不比重度抑郁5 - 6个症状与重度抑郁7 - 9个症状之间的差异大,这表明轻度抑郁与重度抑郁之间具有连续性。再加上早期研究发现亚临床抑郁是重度抑郁的一个重要危险因素,这些结果表明轻度抑郁是抑郁症的一种变体,应作为预防性干预和治疗的目标予以认真考虑。本文最后就未来纵向研究中轻度抑郁亚型的分析提出了建议。