提示: 手机请竖屏浏览!

青少年抑郁症
Depression in Adolescents


Leslie Miller ... 妇产科和儿科 • 2021.07.29
相关阅读
• 赛洛西宾和艾司西酞普兰治疗抑郁症的比较试验 • 初级保健机构中的抑郁症诊治

抑郁症是青少年健康受损和痛苦的重要原因,并被视为自杀危险因素中一项重要的可治疗因素,而自杀是美国青少年的第二大死亡原因1。青少年期抑郁症预示着成人期抑郁症和焦虑症,而且大多数成人患者都是在青少年期首次出现抑郁发作2,这凸显出早期发现并治疗抑郁症的必要性。

 

流行病学特征


虽然各年龄人群的抑郁症患病率都在上升,但青少年中的上升速度超过了成人3。美国13~18岁人群的重性抑郁障碍终身患病率为11.0%,12个月患病率为7.5%4。女性青少年在抑郁症总患病率和发作严重程度方面均超过男性青少年;同样,年龄较大的青少年在患病率和发作严重程度方面均超过年龄较小的青少年4。一次典型发作持续约27周4,青少年抑郁症会阻碍其学业进步,以及达到重要的发育里程碑,例如健康的自主和独立。

由于抑郁症与自杀密切相关,因此青少年抑郁症患病率的上升尤其令人担忧,因为十几近二十年来,青少年自杀率也一直在上升5。男性和女性青少年的自杀率都在上升,而女性自杀率的上升速度尤快,在10~19岁青少年中,男女自杀率比自2007年以来一直在下降,原因很可能是女性青少年越来越多地选择致死性高的自杀手段,例如上吊和窒息6

抑郁症可能呈家族性,抑郁障碍的发生风险可跨越几代人。在一项多代人研究中,父母和祖父母(外祖父母)均患抑郁症的孩子患重性抑郁障碍的概率最高7。还有证据表明,父母患抑郁症会对青少年接受焦虑症和抑郁症治疗后的应答情况产生负面影响8,母亲抑郁症得到成功治疗与年轻后代抑郁症减轻、功能改善相关9。因此,发现并治疗父母的抑郁症有可能改善患抑郁症青少年的结局。

如何及时发现和干预青少年抑郁症是公共卫生领域面临的一项挑战。青少年抑郁症的危险因素包括女性、抑郁症家族史、个人受创史、慢性疾病、家庭冲突和少数性倾向10。美国儿科学会(American Academy of Pediatrics)在其《初级诊疗机构青少年抑郁症治疗指南》(Guidelines for Adolescent Depression in Primary CareGLAD-PC)中为发现和治疗青少年抑郁症制定了框架,包括每年采用经过验证的指标,例如患者健康问卷-9(Patient Health Questionnaire-9,PHQ-9)11,对12~18岁儿童进行抑郁症普遍筛查。





作者信息

Leslie Miller, M.D., and John V. Campo, M.D.
From the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine (L.M., J.V.C.), and the Kennedy Krieger Institute (J.V.C.) — both in Baltimore. Address reprint requests to Dr. Miller at the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5500 E. Lombard St., Baltimore, MD 21224, or at lmille84@jhmi.edu.

 

参考文献

1. Web-based Injury Statistics Query and Reporting System (WISQARS). Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 2018 (https://www.cdc.gov/injury/images/lc-charts/leading_causes_of_death_by_age_group_2018_1100w850h.jpg.).

2. Johnson D, Dupuis G, Piche J, Clayborne Z, Colman I. Adult mental health outcomes of adolescent depression: a systematic review. Depress Anxiety 2018;35:700-716.

3. Weinberger AH, Gbedemah M, Martinez AM, Nash D, Galea S, Goodwin RD. Trends in depression prevalence in the USA from 2005 to 2015: widening disparities in vulnerable groups. Psychol Med 2018;48:1308-1315.

4. Avenevoli S, Swendsen J, He JP, Burstein M, Merikangas KR. Major depression in the national comorbidity survey-adolescent supplement: prevalence, correlates, and treatment. J Am Acad Child Adolesc Psychiatry 2015;54(1):37-44.e2.

5. Curtin SC. State suicide rates among adolescents and young adults aged 10–24: United States, 2000–2018. Natl Vital Stat Rep 2020;69:1-10.

6. Ruch DA, Sheftall AH, Schlagbaum P, Rausch J, Campo JV, Bridge JA. Trends in suicide among youth aged 10 to 19 years in the United States, 1975 to 2016. JAMA Netw Open 2019;2(5):e193886-e193886.

7. Weissman MM, Berry OO, Warner V, et al. A 30-year study of 3 generations at high risk and low risk for depression. JAMA Psychiatry 2016;73:970-977.

8. Gladstone TRG, Diehl A, Thomann LO, Beardslee WR. The association between parental depression and child psychosocial intervention outcomes: directions for future research. Harv Rev Psychiatry 2019;27:241-253.

9. Weissman MM, Wickramaratne P, Pilowsky DJ, et al. Treatment of maternal depression in a medication clinical trial and its effect on children. Am J Psychiatry 2015;172:450-459.

10. Siu AL. Screening for depression in children and adolescents: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2016;164:360-366.

11. Zuckerbrot RA, Cheung A, Jensen PS, Stein REK, Laraque D, GLAD-PC Steering Group. Guidelines for Adolescent Depression in Primary Care (GLAD-PC): part I. Practice preparation, identification, assessment, and initial management. Pediatrics 2018;141(3):e20174081-e20174081.

12. Diagnostic and statistical manual of mental disorders, fifth edition. Arlington, VA: American Psychiatric Association, 2013.

13. Rice F, Riglin L, Lomax T, et al. Adolescent and adult differences in major depression symptom profiles. J Affect Disord 2019;243:175-181.

14. Ratheesh A, Davey C, Hetrick S, et al. A systematic review and meta-analysis of prospective transition from major depression to bipolar disorder. Acta Psychiatr Scand 2017;135:273-284.

15. Gobbi G, Atkin T, Zytynski T, et al. Association of cannabis use in adolescence and risk of depression, anxiety, and suicidality in young adulthood: a systematic review and meta-analysis. JAMA Psychiatry 2019;76:426-434.

16. Emslie GJ, Heiligenstein JH, Hoog SL, et al. Fluoxetine treatment for prevention of relapse of depression in children and adolescents: a double-blind, placebo-controlled study. J Am Acad Child Adolesc Psychiatry 2004;43:1397-1405.

17. Cheung AH, Zuckerbrot RA, Jensen PS, Laraque D, Stein REK, GLAD-PC Steering Group. Guidelines for Adolescent Depression in Primary Care (GLAD-PC): part II. Treatment and ongoing management. Pediatrics 2018;141(3):e20174082-e20174082.

18. Weersing VR, Brent DA, Rozenman MS, et al. Brief behavioral therapy for pediatric anxiety and depression in primary care: a randomized clinical trial. JAMA Psychiatry 2017;74:571-578.

19. Birmaher B, Brent DA, Benson RS. Summary of the practice parameters for the assessment and treatment of children and adolescents with depressive disorders. J Am Acad Child Adolesc Psychiatry 1998;37:1234-1238.

20. Bridge JA, Iyengar S, Salary CB, et al. Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: a meta-analysis of randomized controlled trials. JAMA 2007;297:1683-1696.

21. Ignaszewski MJ, Waslick B. Update on randomized placebo-controlled trials in the past decade for treatment of major depressive disorder in child and adolescent patients: a systematic review. J Child Adolesc Psychopharmacol 2018;28:668-675.

22. March J, Silva S, Petrycki S, et al. Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents With Depression Study (TADS) randomized controlled trial. JAMA 2004;292:807-820.

23. Bridge JA, Birmaher B, Iyengar S, Barbe RP, Brent DA. Placebo response in randomized controlled trials of antidepressants for pediatric major depressive disorder. Am J Psychiatry 2009;166:42-49.

24. Walkup JT. Antidepressant efficacy for depression in children and adolescents: industry- and NIMH-funded studies. Am J Psychiatry 2017;174:430-437.

25. Dwyer JB, Stringaris A, Brent DA, Bloch MH. Annual research review: defining and treating pediatric treatment-resistant depression. J Child Psychol Psychiatry 2020;61:312-332.

26. Brent D, Emslie G, Clarke G, et al. Switching to another SSRI or to venlafaxine with or without cognitive behavioral therapy for adolescents with SSRI-resistant depression: the TORDIA randomized controlled trial. JAMA 2008;299:901-913.

27. Weersing VR, Jeffreys M, Do M-CT, Schwartz KTG, Bolano C. Evidence base update of psychosocial treatments for child and adolescent depression. J Clin Child Adolesc Psychol 2017;46:11-43.

28. Gunlicks-Stoessel M, Klimes-Dougan B, VanZomeren A, Ma S. Developing a data-driven algorithm for guiding selection between cognitive behavioral therapy, fluoxetine, and combination treatment for adolescent depression. Transl Psychiatry 2020;10:321-321.

29. Maruf AA, Greenslade A, Arnold PD, Bousman C. Antidepressant pharmacogenetics in children and young adults: a systematic review. J Affect Disord 2019;254:98-108.

30. Khanna P, Chattu VK, Aeri BT. Nutritional aspects of depression in adolescents — a systematic review. Int J Prev Med 2019;10:42-42.

服务条款 | 隐私政策 | 联系我们