Pettinati H M, Pierce J D, Wolf A L, Rukstalis M R, O'Brien C P
Center for the Study of Addictions, Department of Psychiatry, University of Pennsylvania, Philadelphia 19104-6178, USA.
Alcohol Clin Exp Res. 1997 Dec;21(9):1742-6.
Clinical profiles of alcohol-dependent male and female outpatients were evaluated at treatment entry to compare the level of clinical severity in alcoholics with a coexistent comorbid depressive disorder to alcoholics who have never been depressed. Due to a higher proportion of females than males in the depressed alcoholic population, selected patient groups were oversampled to create a study group with equivalent number of males and females with and without comorbid depression. Clinical severity was assessed by examining both the extent of alcohol problems, and depressive symptomatology at treatment entry with respect to gender differences (unrelated to depression), effects of comorbid depression (unrelated to gender), and effects from the interaction of gender and depression. There were 93 DSM-III-R alcohol-dependent outpatients (50 males, 43 females), half of whom had a current or lifetime DSM-III-R depressive disorder. The amount of drinking in the 90 days before treatment entry, the degree of alcohol severity, and the number of lifetime drinking-related consequences were collected in the first week after detoxification. Diagnoses of lifetime and current depression were determined via the Structured Clinical Interview for DSM-III-R, and depressive symptoms were evaluated with rating scales 1 week after detoxification. In most cases, a depressive disorder was diagnosed only if sometime in the patient's history depressive symptoms had either predated problem drinking or been present during a 6-month abstinent period.
depressed males had a more severe clinical profile with respect to their alcoholism (i.e., more drinking, drinking-related problems, and alcohol severity than depressed females and never-depressed males). Surprisingly, females who had never been depressed (also no family history of depression) reported drinking the same quantities of alcohol in the 90 days before treatment and had comparable alcohol severity and number of consequences as males who had never been depressed. Depressed females, however, were more severely depressed (i.e., reported more intensive depressive symptoms than depressed male alcoholics). Thus, determining the type and extent of clinical severity at treatment entry in comorbidly depressed alcoholics depends on the gender of the patient The significant interaction between gender and the presence of comorbid depression that was found in this study may have important implications for predicting success in treatment.
对酒精依赖的男性和女性门诊患者的临床特征在治疗开始时进行了评估，以比较同时患有共病抑郁障碍的酗酒者与从未患过抑郁症的酗酒者的临床严重程度。由于抑郁酗酒人群中女性比例高于男性，因此对选定的患者组进行了过度抽样，以创建一个男性和女性数量相等、有或没有共病抑郁的研究组。通过检查酒精问题的程度以及治疗开始时的抑郁症状学，评估临床严重程度，涉及性别差异（与抑郁无关）、共病抑郁的影响（与性别无关）以及性别与抑郁相互作用的影响。共有93名符合DSM-III-R酒精依赖的门诊患者（50名男性，43名女性），其中一半患有当前或终生的DSM-III-R抑郁障碍。在排毒后的第一周收集治疗开始前90天的饮酒量、酒精严重程度以及终生与饮酒相关后果的数量。通过DSM-III-R的结构化临床访谈确定终生和当前抑郁症的诊断，并在排毒后1周用评定量表评估抑郁症状。在大多数情况下，只有当患者病史中的抑郁症状在饮酒问题之前出现或在6个月的戒酒期出现时，才诊断为抑郁障碍。
抑郁男性在酗酒方面的临床特征更为严重（即，比抑郁女性和从未抑郁的男性有更多的饮酒、与饮酒相关的问题以及酒精严重程度）。令人惊讶的是，从未抑郁的女性（也没有抑郁家族史）报告在治疗前90天饮酒量与从未抑郁的男性相同，并且酒精严重程度和后果数量相当。然而，抑郁女性的抑郁程度更严重（即，报告的抑郁症状比抑郁男性酗酒者更强烈）。因此，确定共病抑郁酗酒者治疗开始时临床严重程度的类型和程度取决于患者的性别。本研究中发现的性别与共病抑郁之间的显著相互作用可能对预测治疗成功具有重要意义。
