中国社区成人抑郁症临床症状亚型与功能残疾的关系  

Association between clinical symptom subtypes of major depressive disorder and functional disability in Chinese community adults

作　　者：鲁新儒 黄悦勤[2] 李明慧 尹慧芳[3] 侯筱菲[3] 徐广明[3] 严洁 马超 丁华 李强 黄正京[5] 闫永平 寇长贵[7] 胡宓[8] 温静[9] 陈树林[10] 贾存显 LU Xinru;HUANG Yueqin;LI Minghui;YIN Huifang;HOU Xiaofei;XU Guangming;YAN Jie;MA Chao;DING Hua;LI Qiang;HUANG Zhengjing;YAN Yongping;KOU Changgui;HU Mi;WEN Jing;CHEN Shulin;JIA Cunxian(School of Education,Tianjin University,Tianjin 300350,China;Peking University Sixth Hospital,Peking University Institute of Mental Health,NHC Key Laboratory of Mental Health(Peking University),National Clinical Research Center for Mental Disorders(Peking University Sixth Hospital),Beijng 100083,China;Tianjin Anding Hospital,Tianjin 300222,China;Institute of Social Science Survey,Peking University,Beiing 100871,China;National Center for Chronic and Noncommunicable Disease Control and Prevention,Chinese Center for Disease Control and Prevention,Bejjig 100050,China;Department of Epidemiology,School of Public Health,Air Force Medical University,Xi'an 710032,China;Department of Epidemiology and Health Statistics,School of Public Halth,Jilin University,Changchun 130021,China;Xiangya School of Public Health,Central South University,Changsha 410078,China;Ning xia Medical University,Yinchuan 750004,China;Depatment of Psychology and Behavioral Sciences,Zhejiang University,Hangzhou 310028,China;Department of Epidemiology,Shandong University School of Public Health,Sh andong University Center for Suicide Prevention Research,Jinan 250012,China)

机构地区：[1]天津大学教育学院,天津300350 [2]北京大学第六医院,北京大学精神卫生研究所,国家卫生健康委员会精神卫生学重点实验室(北京大学),国家精神心理疾病临床医学研究中心(北京大学第六医院),北京100083 [3]天津市安定医院,天津300222 [4]北京大学中国社会科学调查中心,北京100871 [5]中国疾病预防控制中心慢性非传染性疾病预防控制中心,北京100050 [6]空军军医大学军事预防医学系流行病学教研室,西安710032 [7]吉林大学公共卫生学院流行病与卫生统计学教研室,长春130021 [8]中南大学湘雅公共卫生学院,长沙410078 [9]宁夏医科大学,银川750004 [10]浙江大学心理与行为科学系,杭州310028 [11]山东大学公共卫生学院流行病学系&山东大学自杀预防研究中心,济南250012

出　　处：《中国心理卫生杂志》2021年第12期977-984,共8页Chinese Mental Health Journal

基　　金：国家重点研发计划项目(2017YFC0907800,2017YFC0907801);天津市科技计划项目(18ZXRHSY00100)。

摘　　要：目的:选取具有全国代表性社区成人抑郁症样本,通过基于抑郁症精神病理学的潜在类别分析建立临床亚型,分析亚型与基线和5年后功能残疾的关系。方法:使用2013—2015年中国精神卫生调查数据,共655例18岁以上社区成人抑郁症患者,运用潜在类别分析(LCA)建立临床症状亚型,用Rao-Scottχ^(2)检验和Kruskal-Wallis检验比较各亚型的特征,用logistic回归分析临床亚型与基线和5年后功能残疾的关系。结果:建立忧郁特征伴低自杀风险(39.4%)、低迟滞和低自我否定(25.6%)、非典型(14.7%)和忧郁特征伴高自杀风险(20.3%)4个临床亚型。Logistic回归分析结果表明,抑郁症的临床亚型和基线功能残疾相关。以低迟滞和低自我否定亚型为参照,忧郁特征伴高自杀风险亚型(OR=2.36,95%CI:1.14~4.92)严重功能残疾的风险更高。而抑郁症的临床亚型和5年后的功能残疾无关联。结论:抑郁症临床亚型和基线功能残疾相关,和5年后功能残疾无显著关联。Objective:A sample of adults with major depressive disorder in a nationally repre sentative community was selected,and clinical symptom subtypes were established through the latent class analysis based on the psychopathology of major depressive disorder,and the relationship between subtypes and functional disability at base-line and 5 years later was analyzed.Methods:This study used data from China Mental Health Survey 2013-2015,a total of 655 adults aged 18 years or over with major depressive disorder in the community.Latent class analysis(LCA)was used to establish the clinical symptom subtypes.Rao-Scott χ^(2) test and Kruskal-Wallis test were used to compare the characteristics of each subtype,and logistic regression analysis was used to analyze the relationship between clinical subtypes and functional disability at baseline and 5 years later.Results:Four clinical subtypes were identified,namely melancholy characteristics with low suicide risk(39.4%),low retardation and low self-denial(25.6%),atypical(14.7%),and melancholy characteristics with high suicide risk(20.3%).Logistic regression analysis showed that the clinical subtypes of major depressive disorder were related to baseline functional disability.The subtype of melancholy characteristics with high suicide risk(OR=2.36,95%CI:1.14-4.92)had a higher risk of severe functional disability than the low retardation and low self-denial subtype.However,the clinical sub-type of major depressive disorder was not significantly associated with functional disability after 5 years.Conclusion:The clinical subtypes of major depressive disorder are related to baseline functional disability,but not significantly related to functional disability after 5 years.

关 键 词：抑郁症 临床症状 亚型 潜在类别分析 功能残疾 

分 类 号：R749.41[医药卫生—神经病学与精神病学]