Association between cigarette smoking and anxiety disorders during adolescence and early adulthood

CONTEXT: Cigarette smoking is associated with some anxiety disorders, but the direction of the association between smoking and specific anxiety disorders has not been determined. OBJECTIVE: To investigate the longitudinal association between cigarette smoking and anxiety disorders among adolescents and young adults. DESIGN: The Children in the Community Study, a prospective longitudinal investigation. SETTING AND PARTICIPANTS: Community-based sample of 688 youths (51% female) from upstate New York interviewed in the years 1985-1986, at a mean age of 16 years, and in the years 1991-1993, at a mean age of 22 years. MAIN OUTCOME MEASURE: Participant cigarette smoking and psychiatric disorders in adolescence and early adulthood, measured by age-appropriate versions of the Diagnostic Interview Schedule for Children. RESULTS: Heavy cigarette smoking (>/=20 cigarettes/d) during adolescence was associated with higher risk of agoraphobia (10.3% vs 1.8%; odds ratio [OR], 6.79; 95% confidence interval [CI], 1.53-30.17), generalized anxiety disorder (20.5% vs 3.71%; OR, 5.53; 95% CI, 1.84-16.66), and panic disorder (7.7% vs 0.6%; OR, 15.58; 95% CI, 2.31-105.14) during early adulthood after controlling for age, sex, difficult childhood temperament; alcohol and drug use, anxiety, and depressive disorders during adolescence; and parental smoking, educational level, and psychopathology. Anxiety disorders during adolescence were not significantly associated with chronic cigarette smoking during early adulthood. Fourteen percent and 15% of participants with and without anxiety during adolescence, respectively, smoked at least 20 cigarettes per day during early adulthood (OR, 0.88; 95% CI, 0.36-2.14). CONCLUSION: Our results suggest that cigarette smoking may increase risk of certain anxiety disorders during late adolescence and early adulthood. JAMA. 2000;284:2348-2351.     

Self-harm: 1. Suicide.

Although suicide rates have remained relatively stable, the risk of suicide has increased among 25- to 35-year-old men. Attempts to understand suicide fall into three major frameworks: sociologic theories, psychologic theories and the relation of suicide to psychiatric illness. The risk of suicide can be assessed by means of a relatively simple clinical interview. Since most suicide victims consult their family doctors within the month before their death, physicians are in a unique position to prevent suicide. Routine assessment of the risk of suicide among patients who appear depressed or are undergoing an emotional crisis can lead to accurate diagnosis and effective intervention. Similarly, the appropriate use of psychotropic medication can lead to effective treatment while minimizing the risk of a lethal overdose.     

Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span: findings from the Adverse Childhood Experiences Study.

CONTEXT: Suicide is a leading cause of death in the United States, but identifying persons at risk is difficult. Thus, the US surgeon general has made suicide prevention a national priority. An expanding body of research suggests that childhood trauma and adverse experiences can lead to a variety of negative health outcomes, including attempted suicide among adolescents and adults. OBJECTIVE: To examine the relationship between the risk of suicide attempts and adverse childhood experiences and the number of such experiences (adverse childhood experiences [ACE] score). DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study of 17 337 adult health maintenance organization members (54% female; mean [SD] age, 57 [15.3] years) who attended a primary care clinic in San Diego, Calif, within a 3-year period (1995-1997) and completed a survey about childhood abuse and household dysfunction, suicide attempts (including age at first attempt), and multiple other health-related issues. MAIN OUTCOME MEASURE: Self-reported suicide attempts, compared by number of adverse childhood experiences, including emotional, physical, and sexual abuse; household substance abuse, mental illness, and incarceration; and parental domestic violence, separation, or divorce. RESULTS: The lifetime prevalence of having at least 1 suicide attempt was 3.8%. Adverse childhood experiences in any category increased the risk of attempted suicide 2- to 5-fold. The ACE score had a strong, graded relationship to attempted suicide during childhood/adolescence and adulthood (P<.001). Compared with persons with no such experiences (prevalence of attempted suicide, 1.1%), the adjusted odds ratio of ever attempting suicide among persons with 7 or more experiences (35.2%) was 31.1 (95% confidence interval, 20.6-47.1). Adjustment for illicit drug use, depressed affect, and self-reported alcoholism reduced the strength of the relationship between the ACE score and suicide attempts, suggesting partial mediation of the adverse childhood experience-suicide attempt relationship by these factors. The population-attributable risk fractions for 1 or more experiences were 67%, 64%, and 80% for lifetime, adult, and childhood/adolescent suicide attempts, respectively. CONCLUSIONS: A powerful graded relationship exists between adverse childhood experiences and risk of attempted suicide throughout the life span. Alcoholism, depressed affect, and illicit drug use, which are strongly associated with such experiences, appear to partially mediate this relationship. Because estimates of the attributable risk fraction caused by these experiences were large, prevention of these experiences and the treatment of persons affected by them may lead to progress in suicide prevention.     

精神科急诊患者的自杀危险因素分析

目的 旨在评估精神科急诊患者自杀的临床、心理、社会学和生物学危险因素。方法 对首都医科大学附属北京安定医院2015至2017年精神科急诊就诊患者进行横断面分析,采用自杀危险因素评估表对患者进行自杀想法和行为(suicidal thoughts and behaviors,STB)检测,得分≤10分和>10分分别表示STB的存在和不存在,多因素Logistic回归分析确定STB的危险因素。结果 共纳入12 345例患者,其中女性6 885例(56%)。患者年龄36(27～50)岁,简明精神病评定量表(Brief Psychiatric Rating Scale,BPRS)总分、汉密尔顿焦虑量表(Hamilton Anxiety Scale,HAMA)总分、汉密尔顿抑郁量表(Hamilton Depression Scale,HAMD)总分、杨氏躁狂量表(Yung Manic Rating Scale,YMRS)总分平均分分别为32(27～39)分、7(3～13)分、10(6～15)分和7(4～18)分。根据自杀风险评估表,有3 436例(27.83%)患者有STB的危险。多因素分析显示,居住地、性别、婚姻状况、同住者、受教育年限、职业状况、与父母和兄弟姐妹的关系、诱因、性格、确定诊断、躯体疾病、简明精神疾病总分、焦虑总分、抑郁总分、躁狂总分、就医时间、精神科住院总次数是STB的独立危险因素。结论 精神科急诊患者自杀风险较高,以中青年为主,尤其以男性、未婚、失业、社会和家庭支持较差的精神疾病患者为著。STB在这一人群中受到生理、心理和社会因素的影响。     

The presence and accessibility of firearms in the homes of adolescent suicides. A case-control study.

OBJECTIVE--The presence of guns in the home, the type of gun, and the method of storage were all hypothesized to be associated with risk for adolescent suicide. DESIGN--Case-control study. SUBJECTS--The case group consisted of 47 adolescent suicide victims. The two psychiatric inpatient control groups were 47 suicide attempters and 47 never-suicidal psychiatric controls, frequency-matched to the suicide victims on age, gender, and county of origin. SETTING--The cases were a consecutive community sample, whereas the inpatients were drawn from a university psychiatric hospital. MAIN OUTCOME MEASURE--Odds of the presence of guns in the home of suicide victims (cases) relative to controls. RESULTS--Guns were twice as likely to be found in the homes of suicide victims as in the homes of attempters (adjusted odds ratio, 2.1; 95% confidence interval, 1.2 to 3.7) or psychiatric controls (adjusted odds ratio, 2.2; 95% confidence interval, 1.4 to 3.5). Handguns were not associated with suicide to any statistically significantly greater extent than long guns. There was no difference in the methods of storage of firearms among the three groups, so that even guns stored locked, or separate from ammunition, were associated with suicide by firearms. CONCLUSIONS--The availability of guns in the home, independent of firearms type or method of storage, appears to increase the risk for suicide among adolescents. Physicians should make a clear and firm recommendation that firearms be removed from the homes of adolescents judged to be at suicidal risk.     

Depression in adolescence: new developments

Depression in adolescence is under-recognized although its associated burden of illness is very high. Some frequent associations with depression in this age group are under-achievement, poor lifestyle choices including substance abuse, and a high risk of the persistence of the illness into adulthood There is also an increased risk of mortality related to suicide and harmful lifestyles. For depression in adolescents to be reduced, there needs to be strong collaboration among health professions, adolescents and their caregivers. Non-mental health clinicians must expand their role and become better prepared to recognize, prevent and treat depression in this age-group. Greater public awareness must also be achieved so that adolescents and their caregivers can seek help early.     

Pituitary-adrenal and autonomic responses to stress in women after sexual and physical abuse in childhood

CONTEXT: Evidence suggests that early adverse experiences play a preeminent role in development of mood and anxiety disorders and that corticotropin-releasing factor (CRF) systems may mediate this association. OBJECTIVE: To determine whether early-life stress results in a persistent sensitization of the hypothalamic-pituitary-adrenal axis to mild stress in adulthood, thereby contributing to vulnerability to psychopathological conditions. DESIGN AND SETTING: Prospective controlled study conducted from May 1997 to July 1999 at the General Clinical Research Center of Emory University Hospital, Atlanta, Ga. PARTICIPANTS: Forty-nine healthy women aged 18 to 45 years with regular menses, with no history of mania or psychosis, with no active substance abuse or eating disorder within 6 months, and who were free of hormonal and psychotropic medications were recruited into 4 study groups (n = 12 with no history of childhood abuse or psychiatric disorder [controls]; n = 13 with diagnosis of current major depression who were sexually or physically abused as children; n = 14 without current major depression who were sexually or physically abused as children; and n = 10 with diagnosis of current major depression and no history of childhood abuse). MAIN OUTCOME MEASURES: Adrenocorticotropic hormone (ACTH) and cortisol levels and heart rate responses to a standardized psychosocial laboratory stressor compared among the 4 study groups. RESULTS: Women with a history of childhood abuse exhibited increased pituitary-adrenal and autonomic responses to stress compared with controls. This effect was particularly robust in women with current symptoms of depression and anxiety. Women with a history of childhood abuse and a current major depression diagnosis exhibited a more than 6-fold greater ACTH response to stress than age-matched controls (net peak of 9.0 pmol/L [41.0 pg/mL]; 95% confidence interval [CI], 4.7-13.3 pmol/L [21.6-60. 4 pg/mL]; vs net peak of 1.4 pmol/L [6.19 pg/mL]; 95% CI, 0.2-2.5 pmol/L [1.0-11.4 pg/mL]; difference, 8.6 pmol/L [38.9 pg/mL]; 95% CI, 4.6-12.6 pmol/L [20.8-57.1 pg/mL]; P<.001). CONCLUSIONS: Our findings suggest that hypothalamic-pituitary-adrenal axis and autonomic nervous system hyperreactivity, presumably due to CRF hypersecretion, is a persistent consequence of childhood abuse that may contribute to the diathesis for adulthood psychopathological conditions. Furthermore, these results imply a role for CRF receptor antagonists in the prevention and treatment of psychopathological conditions related to early-life stress. JAMA. 2000;284:592-597     

Risk of suicide among persons with AIDS. A national assessment.

OBJECTIVE--We sought to describe the rate, risk, trends, methods, and distribution of suicide among persons with the acquired immunodeficiency syndrome (AIDS) in the United States. DESIGN--We used National Center for Health Statistics multiple-cause mortality data from 1987 through 1989 to identify suicides among persons with AIDS (PWAs) and public-access AIDS surveillance data to determine person-years of observation of PWAs. PATIENTS--Residents of the United States with death certificates indicating suicide. MAIN OUTCOME MEASURE--Death certificates indicating both AIDS and suicide. RESULTS--In 1987 through 1989, a total of 165 suicides among PWAs occurred in 45 states and the District of Columbia. All but one case were male. Among males the rate was 165 per 100,000 person-years of observation, 7.4-fold higher than among demographically similar men in the general population. Self-poisoning with drugs was both the most common method (35%) and the method with the highest standardized mortality ratio (35). Suicide risk for PWAs decreased significantly (P < .05) from 1987 to 1989. CONCLUSION--Persons with AIDS have an increased risk of suicide, and assessment of such risk should be a standard practice in their care. These assessments should be carefully considered when potentially lethal medications are prescribed. The declining trend in suicide rates between 1987 and 1989 is encouraging; possible causes include emerging therapies for human immunodeficiency virus/AIDS, better psychiatric care for these patients, and lessened social stigma against PWAs.     

Mental health, social functioning, and attitudes of Kosovar Albanians following the war in Kosovo

CONTEXT: The 1998-1999 war in Kosovo had a direct impact on large numbers of civilians. The mental health consequences of the conflict are not known. OBJECTIVES: To establish the prevalence of psychiatric morbidity associated with the war in Kosovo, to assess social functioning, and to identify vulnerable populations among ethnic Albanians in Kosovo. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional cluster sample survey conducted from August to October 1999 among 1358 Kosovar Albanians aged 15 years or older in 558 randomly selected households across Kosovo. MAIN OUTCOME MEASURES: Nonspecific psychiatric morbidity, posttraumatic stress disorder (PTSD) symptoms, and social functioning using the General Health Questionnaire 28 (GHQ-28), Harvard Trauma Questionnaire, and the Medical Outcomes Study Short-Form 20 (MOS-20), respectively; feelings of hatred and a desire for revenge among persons surveyed as addressed by additional questions. RESULTS: Of the respondents, 17.1% (95% confidence interval [CI], 13.2%-21.0%) reported symptoms that met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for PTSD; total mean score on the GHQ-28 was 11.1 (95% CI, 9.9-12.4). Respondents reported a high prevalence of traumatic events. There was a significant linear decrease in mental health status and social functioning with increasing amount of traumatic events (P相似文献   

Prevention of suicide.

We reviewed the epidemiologic features of suicide in Canada and evaluated suicide prevention programs. Three groups were found to be at increased risk for suicide: men aged 70 years or more, women aged 65 to 69 and men aged 20 to 24. The other groups, in decreasing order of risk, were the mentally ill, people who have attempted suicide, those with a life-threatening illness, native people, people with a family history of suicide and prisoners. Studies that evaluated suicide prevention programs showed that none significantly reduced the incidence of suicide; however, the studies were found to be methodologically inadequate or used noncomparable systems of data collection. On the basis of our findings we recommend that primary care physicians routinely evaluate suicide risk among patients in high-risk groups and that intervention include counselling, follow-up and, if necessary, referral to a psychiatrist. Close follow-up is recommended for newly discharged psychiatric patients and those who recently attempted suicide.     

杭州市2000-2009年院前急救自杀患者分析

目的:分析杭州市2000-2009年院前急救自杀患者的流行病学特点。方法:在杭州市急救中心2000-2009年院前急救数据库中选择记录完整的自杀病例,采用EXCEL2007和SPSS13.0对数据进行统计学分析,探讨其流行病学意义。结果:自2002年以来自杀病例一直有增长趋势,最高1年(2007)较最少1年(2002)增长近10倍,近年来持续走高;944例自杀病例中,男性303人次,女性641人次,女性显著多于男性,男女比为1:2.12,各年龄段女性均多于男性;59-40岁及39-20岁两年龄段人数最多,分别占总自杀人数的13.24%和66.53%;3月、5月明显高于其他月份,2月份为最少。结论:应根据流行病学特点,不断完善对自杀病人的急救预警机制,加强急救队伍的整体实力和提高人们的心理素质,减少自杀事件的发生。     

大一新生生命意义感在其家庭功能与自杀风险之间的中介效应

目的　探讨大一新生生命意义感在其家庭功能与自杀风险之间的中介效应,为进一步预防大学生自杀提供依据。方法　2015年11月,选取南方医科大学全日制本科2015级2 900例大一全体新生为研究对象进行问卷调查。调查问卷包括人口学资料、自杀行为问卷-修订版（SBQ-R）、家庭关怀度指数问卷（APGAR）、生命意义量表（MLM）。分析大一新生生命意义感在其家庭功能与自杀风险之间的中介效应。结果　共发放调查问卷2 900份,回收有效问卷2 787份,有效回收率为96.1%。2 787例大学生中男979例（35.1%）,女1 808例（64.9%）;平均年龄（18.4±0.8）岁。大学生SBQ-R、APGAR、MLM得分分别为（4.2±1.5）、（7.8±2.3）、（129.9±17.5）分;大学生APGAR、MLM得分与SBQ-R得分呈负相关（P<0.05）;大学生MLM得分与APGAR得分呈正相关（P<0.05）。APGAR对自杀风险的直接效应显著（β=-0.176,P<0.001）,中介变量MLM得分对自杀风险的负向预测作用显著（β=-0.270,P<0.001）,说明生命意义感在家庭功能和自杀风险之间存在部分中介效应,效应值为0.12,中介效应占总效应的比例为41%。结论　生命意义感在大学生家庭功能与自杀风险之间起部分中介作用。     

Suicide risk among recently released prisoners in New South Wales, Australia

OBJECTIVE: To determine the risk of suicide and drug overdose death among recently released prisoners. DESIGN, SETTING AND PARTICIPANTS: Retrospective cohort study of 85 203 adult offenders who had spent some time in full-time custody in prisons in New South Wales between 1 January 1988 and 31 December 2002. MAIN OUTCOME MEASURES: Association between time after release and risk of suicide and overdose death. RESULTS: Of 844 suicides (795 men, 49 women), 724 (86%) occurred after release. Men had a higher rate of suicide than women both in prison (129 v 56 per 100,000 person-years) and after release (135 v 82 per 100,000 person-years). The suicide rate in men in the 2 weeks after release was 3.87 (95% CI, 2.26-6.65) times higher than the rate after 6 months. Male prisoners admitted to the prison psychiatric hospital had a threefold higher risk than non-admitted men both in prison and after release. No suicides among women were observed in the 2 weeks after release. No increased risk of suicide was observed among Aboriginal Australians in the first 2 weeks after release. Of 1674 deaths due to overdose, 1627 (97%) occurred after release. Drug-related mortality in men was 9.30 (95% CI, 7.80-11.10) times higher, and in women was 6.42 (95% CI, 3.88-10.62) times higher, in the 2 weeks after release than after 6 months. CONCLUSIONS: Prisoners are at a heightened risk of suicide and overdose death in the immediate post-release period. After 6 months post-release, the suicide rate approaches the rate observed in custody.     

Caregiving as a risk factor for mortality: the Caregiver Health Effects Study

CONTEXT: There is strong consensus that caring for an elderly individual with disability is burdensome and stressful to many family members and contributes to psychiatric morbidity. Researchers have also suggested that the combination of loss, prolonged distress, the physical demands of caregiving, and biological vulnerabilities of older caregivers may compromise their physiological functioning and increase their risk for physical health problems, leading to increased mortality. OBJECTIVE: To examine the relationship between caregiving demands among older spousal caregivers and 4-year all-cause mortality, controlling for sociodemographic factors, prevalent clinical disease, and subclinical disease at baseline. DESIGN: Prospective population-based cohort study, from 1993 through 1998 with an average of 4.5 years of follow-up. SETTING: Four US communities. PARTICIPANTS: A total of 392 caregivers and 427 noncaregivers aged 66 to 96 years who were living with their spouses. MAIN OUTCOME MEASURE: Four-year mortality, based on level of caregiving: (1) spouse not disabled; (2) spouse disabled and not helping; (3) spouse disabled and helping with no strain reported; or(4) spouse disabled and helping with mental or emotional strain reported. RESULTS: After 4 years of follow-up, 103 participants (12.6%) died. After adjusting for sociodemographic factors, prevalent disease, and subclinical cardiovascular disease, participants who were providing care and experiencing caregiver strain had mortality risks that were 63% higher than noncaregiving controls (relative risk [RR], 1.63; 95% confidence interval [CI], 1.00-2.65). Participants who were providing care but not experiencing strain (RR, 1.08; 95 % CI, 0.61-1.90) and those with a disabled spouse who were not providing care (RR, 1.37; 95% CI, 0.73-2.58) did not have elevated adjusted mortality rates relative to the noncaregiving controls. CONCLUSIONS: Our study suggests that being a caregiver who is experiencing mental or emotional strain is an independent risk factor for mortality among elderly spousal caregivers. Caregivers who report strain associated with caregiving are more likely to die than noncaregiving controls.     

Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: a meta-analysis of randomized controlled trials

Context  The US Food and Drug Administration (FDA) has issued warnings that use of antidepressant medications poses a small but significantly increased risk of suicidal ideation/suicide attempt for children and adolescents. Objective  To assess the efficacy and risk of reported suicidal ideation/suicide attempt of antidepressants for treatment of pediatric major depressive disorder (MDD), obsessive-compulsive disorder (OCD), and non-OCD anxiety disorders. Data Sources and Study Selection  PubMed (1988 to July 2006), relevant US and British regulatory agency reports, published abstracts of important scientific meetings (1998-2006), clinical trial registries, and information from authors. Studies were published and unpublished randomized, placebo-controlled, parallel-group trials of second-generation antidepressants (selective serotonin reuptake inhibitors, nefazodone, venlafaxine, and mirtazapine) in participants younger than 19 years with MDD, OCD, or non-OCD anxiety disorders. Data Extraction  Information was extracted on study characteristics, efficacy outcomes, and spontaneously reported suicidal ideation/suicide attempt. Data Synthesis  Twenty-seven trials of pediatric MDD (n = 15), OCD (n = 6), and non-OCD anxiety disorders (n = 6) were selected, and risk differences for response and for suicidal ideation/suicide attempt estimated by random-effects methods. Pooled risk differences in rates of primary study-defined measures of responder status significantly favored antidepressants for MDD (11.0%; [95% confidence interval {CI}, 7.1% to 14.9%]), OCD (19.8% [95% CI, 13.0% to 26.6%), and non-OCD anxiety disorders (37.1% [22.5% to 51.7%]), corresponding to a number needed to treat (NNT) of 10 (95% CI, 7 to 15), 6 (4 to 8), and 3 (2 to 5), respectively. While there was increased risk difference of suicidal ideation/suicide attempt across all trials and indications for drug vs placebo (0.7%; 95% CI, 0.1% to 1.3%) (number needed to harm, 143 [95% CI, 77 to 1000]), the pooled risk differences within each indication were not statistically significant: 0.9% (95% CI, –0.1% to 1.9%) for MDD, 0.5% (–1.2% to 2.2%) for OCD, and 0.7% (–0.4% to 1.8%) for non-OCD anxiety disorders. There were no completed suicides. Age-stratified analyses showed that for children younger than 12 years with MDD, only fluoxetine showed benefit over placebo. In MDD trials, efficacy was moderated by age, duration of depression, and number of sites in the treatment trial. Conclusions  Relative to placebo, antidepressants are efficacious for pediatric MDD, OCD, and non-OCD anxiety disorders, although the effects are strongest in non-OCD anxiety disorders, intermediate in OCD, and more modest in MDD. Benefits of antidepressants appear to be much greater than risks from suicidal ideation/suicide attempt across indications, although comparison of benefit to risk varies as a function of indication, age, chronicity, and study conditions.      

Suicides by prisoners

In a consecutive series of 44 deaths of male prisoners in Brisbane Prison, a maximum-security prison, in the 15-year period 1973-1987, 20 deaths were a result of suicide. More than half the suicides occurred within the first two months in custody. Prisoners on remand were more prone to commit suicide than were sentenced prisoners. A history of psychiatric disorder was frequent, and more than one-third of the prisoners previously had received psychiatric inpatient treatment. In 40% of cases suicide had been attempted previously. Hanging was the usual method of suicide. The application of preventive measures in the presence of risk factors for suicide at the present level of knowledge are discussed.     

重性抑郁障碍患者血浆天冬氨酸和甘氨酸及天冬酰胺水平的变化

目的:分析重性抑郁障碍患者(Major depressive disorder,MDD)血浆兴奋性氨基酸类神经递质天冬氨酸( Aspartic acid,Asp)和抑制性神经递质甘氨酸(Glycine,Gly),以及氨基酸天冬酰胺( Asparagine,Asn)水平的变化.方法:收集15例首发重性抑郁障碍患者(男9例,女6例,年龄32～ 64岁)和14例健康对照者(男7例,女7例,年龄30～ 65岁)的血浆,其中7例MDD患者(男5例,女2例)在抗抑郁治疗两月后的随访中再次留取血浆.采用高效液相色谱—荧光法测定血浆中Asp、Gly、Asn含量.结果:(1)MDD患者血浆Asp、Gly水平均显著低于健康对照组(p≤0.033),Asn水平和健康对照组相比无显著差异(P =0.208).(2)在健康对照组,血浆Gly与Asp、Asn水平分别呈现显著正相关(P≤0.004).在MDD患者,血浆Gly水平与Asp水平的相关性消失 (P=0.538),而Gly水平和Asn水平保持相关性(p＜0.001).(3)抗抑郁治疗两个月后MDD患者临床症状显著改善,血浆Asp、Gly、Asn水平和治疗前相比无显著差异(P≥0.306),氨基酸水平之间的相关性也无改变.结论:血浆Asp和Gly水平降低可能是MDD的一个特征性生物学指标.     

The epidemiologic catchment area (ECA) study: implications for Australia.

OBJECTIVES: To make clinicians aware of the methods and results of the Epidemiologic Catchment Area (ECA) study, the largest (about 20,000 subjects) undertaken in psychiatric epidemiology, and to explore implications for the management of these conditions in Australia. DATA SOURCES: The main source was the monograph that reports the overall results of the ECA project. Data extraction: Only data that were considered to be of general interest were extracted. DATA SYNTHESIS: The ECA study found that one in every three American adults had experienced one or more of 30 major psychiatric disorders at some time in their lives. One in five had an active disorder at the time of interview. Most conditions were found to have their onset early in life (median age of onset was 16 years) and followed a chronic course. In many cases persons afflicted did not seek or receive appropriate treatment despite using medical services more often. CONCLUSIONS: Psychiatric disorders are a major public health problem. Increased emphasis on their identification and treatment is required, particularly during childhood, adolescence and early adulthood. Paradoxically, these are the age groups more neglected by current services and research.     

Suicide among women: a critical review

Despite increasing attention to suicide as a preventable outcome associated with mood disorders, little attention has been given to the risk factors for suicide among women. In this paper, we: 1) review the current literature regarding risk factors for suicide among women; 2) address the theories regarding risk and protective factors for women; 3) integrate the findings into a practical assessment of women's risk of suicide in clinical settings; and 4) consider avenues for future research.