Zisook S, Paulus M, Shuchter S R, Judd L L
University of California, San Diego, Department of Psychiatry, La Jolla 92093, USA.
J Affect Disord. 1997 Aug;45(1-2):85-94; discussion 94-5. doi: 10.1016/s0165-0327(97)00062-1.
While it is becoming increasingly clear that mood disorders tend to be chronic, intermittent and/or recurrent conditions with different manifestations over time, little is known of the variability or course of mood disorders that are associated with severe psychosocial stress. This paper reports on the prevalence and course of major, minor, and subsyndromal depressions in 328 widows and widowers followed prospectively from 2 to 25 months following one of the most disruptive of all naturally occurring stressors, spousal bereavement. The results are consistent with the following conclusions: (1) past major depression (prior to the death) predicts an increased risk for major depression following bereavement; (2) membership in any of the unipolar subgroups, in turn, predicts future depression throughout the unipolar depressive spectrum; (3) subsyndromal and minor depression stand between major depression, on the one hand, and no depression, on the other, in terms of their effects on overall adjustment to widowhood. Thus, the results support the validity of subsyndromal depression, and that the three subgroups (major, minor and subsyndromal depression) are pleiomorphic manifestations of the same unipolar depression disorder.
虽然越来越明显的是，情绪障碍往往是慢性、间歇性和/或复发性疾病，且随着时间推移会有不同表现，但对于与严重心理社会压力相关的情绪障碍的变异性或病程却知之甚少。本文报告了328名寡妇和鳏夫中重度、轻度和亚综合征性抑郁的患病率及病程，这些人在经历了所有自然发生的压力源中最具破坏性的一种——配偶丧亡后，被前瞻性地跟踪了2至25个月。结果与以下结论一致：(1) 过去的重度抑郁（在死亡前）预示着丧亲后患重度抑郁的风险增加；(2) 反过来，任何单相亚组中的成员身份都预示着未来在整个单相抑郁谱系中会出现抑郁；(3) 就其对丧偶后整体适应的影响而言，亚综合征性和轻度抑郁一方面介于重度抑郁和另一方面无抑郁之间。因此，结果支持了亚综合征性抑郁的有效性，以及这三个亚组（重度、轻度和亚综合征性抑郁）是同一单相抑郁障碍的多形性表现。
