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首页> 外文期刊>The journal of clinical psychiatry >Risks for the transition from major depressive disorder to bipolar disorder in the National Epidemiologic Survey on alcohol and related conditions
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Risks for the transition from major depressive disorder to bipolar disorder in the National Epidemiologic Survey on alcohol and related conditions

机译：全国酒精和相关疾病流行病学调查显示从重度抑郁症转变为双相情感障碍的风险

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Objective: It is currently not possible to determine which individuals with unipolar depression are at highest risk for a manic episode. This study investigates clinical and psychosocial risk factors for mania among individuals with major depressive disorder (MDD), indicating diagnostic conversion from MDD to bipolar I disorder. Method: We fitted logistic regression models to predict the first onset of a manic episode among 6,214 cases of lifetime MDD according to DSM-IV criteria in the National Epidemiologic Survey on Alcohol and Related Conditions. Participants in this survey were interviewed twice over a period of 3 years, in 2000-2001 and in 2004-2005, and survey data were gathered using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV. Results: Approximately 1 in 25 individuals with MDD transitioned to bipolar disorder during the study's 3-year follow-up period. Demographic risk factors for the transition from MDD to bipolar disorder included younger age, black race/ethnicity, and less than high school education. Clinical characteristics of depression (eg, age at first onset, presence of atypical features) were not associated with diagnostic conversion. However, prior psychopathology was associated with the transition to bipolar disorder: history of social phobia (odds ratio [OR] = 2.20; 95% confidence interval [CI], 1.47-3.30) and generalized anxiety disorder (OR = 1.58; 95% CI, 1.06-2.35). Lastly, we identified environmental stressors over the life course that predicted the transition to bipolar disorder: these include a history of child abuse (OR = 1.26; 95% CI, 1.12-1.42) and past-year problems with one's social support group (OR = 1.79; 95% CI, 1.19-2.68). The overall predictive power of these risk factors based on a receiver operating curve analysis is modest. Conclusions: A wide range of demographic, clinical, and environmental risk factors were identified that indicate a heightened risk for the transition to bipolar disorder. Additional work is needed to further enhance the prediction of bipolar disorder among cases of MDD and to determine whether interventions targeting these factors could reduce the risk of bipolar disorder.
机译：目的：目前尚无法确定哪些单极抑郁症患者发生躁狂发作的风险最高。这项研究调查了患有重度抑郁症（MDD）的个体中躁狂症的临床和心理社会危险因素，这表明从MDD诊断性转变为双相I型障碍。方法：我们根据国家酒精与相关疾病流行病学调查中的DSM-IV标准，拟合了logistic回归模型来预测6214例终生MDD病例中的躁狂发作的首次发作。在2000年至2001年以及2004年至2005年的3年中，本次调查的参与者进行了两次访谈，并使用《酒精使用障碍和伴随残障人士访谈时间表IV》收集了调查数据。结果：在研究的3年随访期内，约25名MDD患者中有1名转变为躁郁症。从MDD转变为双相情感障碍的人口统计学风险因素包括年龄较小，黑人种族/民族和中学教育程度以下。抑郁症的临床特征（例如初发年龄，不典型特征的出现）与诊断转换无关。然而，先前的精神病理学与双相情感障碍的转变有关：社交恐惧症的历史（几率[OR] = 2.20; 95％的置信区间[CI]，1.47-3.30）和广泛性焦虑症（OR = 1.58; 95％CI ，1.06-2.35）。最后，我们在整个生命过程中确定了环境压力源，这些压力源可预测到躁郁症的过渡：包括虐待儿童的历史（OR = 1.26; 95％CI，1.12-1.42）和过去一个人的社会支持小组存在的问题（OR ＝ 1.79; 95％CI，1.19-2.68）。基于接收者工作曲线分析的这些风险因素的总体预测能力是适度的。结论：确定了广泛的人口统计学，临床和环境风险因素，这些因素表明患双相情感障碍的风险增加。需要进一步的工作来进一步增强MDD病例中双相情感障碍的预测，并确定针对这些因素的干预措施是否可以降低双相情感障碍的风险。

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