Kessler R C, Stang P E, Wittchen H U, Ustun T B, Roy-Burne P P, Walters E E
Department of Health Care Policy, Harvard Medical School, Boston, Mass 02115, USA.
Arch Gen Psychiatry. 1998 Sep;55(9):801-8. doi: 10.1001/archpsyc.55.9.801.
The National Comorbidity Survey is a nationally representative survey of the prevalences and correlates of DSM-III-R disorders in the US household population.
Retrospective age-at-onset reports were used to study predictive relationships between lifetime panic and depression.
Strong associations were found between the lifetime prevalences of panic and major depressive episodes (odds ratios: for panic attacks with depression, 6.2; for panic disorder with depression, 6.8). These associations were not significantly influenced by the inclusion or exclusion of respondents with mania. Temporally primary depression predicted a first onset of subsequent panic attacks but not of panic disorder. Temporally primary panic attacks, with or without panic disorder and whether or not the panic was persistent, predicted a first onset of subsequent major depression. The associations between panic attack and depression were attenuated in models that controlled for prior traumatic life experiences and histories of other DSM-III-R disorders.
Lifetime panic-depression comorbidity characterizes most community respondents with panic disorder and a substantial few of those with major depression. The absence of a dose-response relationship suggests that primary panic attack is a marker, rather than a causal risk factor, of subsequent depression. Primary depression, in comparison, appears to be a genuine risk factor for secondary panic attacks. That primary depression predicts panic attacks but not panic disorder suggests that secondary panic is a severity marker of depression rather than a comorbid condition. These results are far from definitive because they are based on retrospective reports, lay-administered diagnostic interviews, and only 1 survey. However, they raise important questions that could lead to a fundamental rethinking of panic-depression comorbidity if they are replicated in future epidemiological and clinical studies.
全国共病调查是一项对美国家庭人口中 DSM-III-R 障碍的患病率及其相关因素具有全国代表性的调查。
采用回顾性发病年龄报告来研究终生惊恐障碍与抑郁症之间的预测关系。
发现惊恐障碍和重度抑郁发作的终生患病率之间存在强关联（优势比：伴有抑郁症的惊恐发作，6.2；伴有抑郁症的惊恐障碍，6.8）。这些关联不受是否纳入躁狂症患者的显著影响。时间上首发的抑郁症可预测随后惊恐发作的首次发病，但不能预测惊恐障碍的首次发病。时间上首发的惊恐发作，无论是否伴有惊恐障碍以及惊恐是否持续，均可预测随后重度抑郁症的首次发病。在控制了既往创伤性生活经历和其他 DSM-III-R 障碍病史的模型中，惊恐发作与抑郁症之间的关联减弱。
终生惊恐障碍与抑郁症共病是大多数患有惊恐障碍的社区受访者以及少数患有重度抑郁症的受访者的特征。不存在剂量反应关系表明，原发性惊恐发作是随后抑郁症的一个标志，而非因果风险因素。相比之下，原发性抑郁症似乎是继发性惊恐发作的真正风险因素。原发性抑郁症可预测惊恐发作但不能预测惊恐障碍，这表明继发性惊恐是抑郁症的严重程度标志，而非共病情况。这些结果远非定论，因为它们基于回顾性报告、由非专业人员进行的诊断访谈，且仅来自 1 项调查。然而，如果在未来的流行病学和临床研究中得到重复验证，它们将引发重要问题，可能导致对惊恐障碍与抑郁症共病的根本重新思考。
