单相抑郁症患者自杀行为遗传效应及其遗传方式的研究(英文)

Hereditary effects and patterns of suicidal behavior in unipolar depressed patients

背景:遗传因素在抑郁症自杀行为的发生中占有一定的地位,以往的关注的重点主要为双相抑郁自杀的遗传效应,单相抑郁症自杀行为的遗传方式和遗传效应有何特征?目的:探讨单相抑郁症自杀行为的遗传效应及遗传方式。设计:回顾性调查。单位:一所市级精神卫生中心。对象:单相抑郁症组(n=115)为1983-06-01/2002-05-31无锡市精神卫生中心门诊和住院诊断为抑郁症的患者。诊断均符合中国精神障碍分类与诊断标准第3版抑郁发作及美国精神障碍诊断与统计手册第4版重性抑郁发作标准,且抑郁发作次数≥3次或发作一两次已缓解≥8年者。方法:以符合入组标准的单相抑郁症患者为先证者,由2名主治医师及其以上医师对每一家系进行调查,填写自行编制的精神病家系调查表,内容主要包括患者及一级亲属所有成员社会人口学资料、疾病发作特点及次数、以往治疗及自杀情况。由2名主治医师或以上医师对每一患者进行再诊断,并由1名主任医师核查,一致确诊的病例则予入组。对所有现存活的先症者(107例)及一级亲属中有自杀行为者(14例)进行面检;对无自杀行为的一级亲属(337名)进行面检和信函调查(380名);死亡者(患者8例,一级亲属5例)的资料由一两名一级亲属提供有关情况填写调查表。对照组由2名研究者进行面检,同时询问一级亲属情况并填写家系调查表。对所得资料行单因素分析,用多基因阈值理论Falconer模式估算自杀行为的遗传率和标准误,用医学遗传数学方法中分离分析法和多基因阈值理论进行遗传方式的探讨。主要观察指标:单相抑郁症患者自杀行为的遗传效应和遗传方式。结果:单相抑郁症患者自杀危险性51.30%(59/115)较其一级亲属2.58%(19/736)高(χ2=283.16,P<0.01),单相抑郁症患者一级亲属自杀危险性2.58%(19/736)较对照组0.12%(3/2469)高(χ2=50.36,P<0.01),有自杀行为患者的一级亲属自杀危险性3.8%(14/372)较无自杀行为患者的一级亲属自杀危险性1.4%(5/363)高(χ2=4.14,P<0.05)。单相抑郁症自杀行为的加权平均遗传率及标准误为(70.16±0.79)%;多基因遗传方式验证显示,多基因遗传方式验证显示一级亲属自杀行为预期发病率为3.1%,实际发病率为2.6%,两者差异无显著性意义(u=0.766,P>0.05)。结论:单相抑郁症自杀行为有明显的遗传效应,其遗传方式符合多基因遗传。

BACKGROUND：Hereditary factor occupies a certain position in suicidal behavior of depression. The researches in the past are focusedon the hereditary effect on bipolar depression suicide.How do hereditary patterns and effects work in suicidal behavior in unipolar depression？OBJECTIVE： To probe into hereditary patterns and effects on suicidal behavior in unipolar depression.DESIGN：Retrospective investigation.SETTING：A municipal psychiatric hygienic center PARTICIPANTS：Unipolar depression group included 115 outpatients and inpatients diagnosed in Wuxi Psychiatric Hygienic Center from June 1^st 1983 to May 31^st 2002.The diagnosis tallied with Standards on Depression Onset in Categories and Diagnostic Standards on Psychiatric Disturbance in China of 3^rd Edition and with Standards on Severe Depression Onset in Manual of Diagnosis and Statistics of Psychiatric Disturbance in America of 4^th Edition.The attack frequency of all the cases ≥ 3 times or the cases had been relieved ≥8 years after a couple of attacks.METHODS：The patients who tallied with the standards on unipolar depression received the investigation in every family tree under the instruction of 2 physicians-in-charge and more than 2 physicians and filled up the self-made investigation form of psychiatric family tree,including mainly the data of social demography of patients and their first grade relatives,characters of disease onset,frequency of attack,history of treatment and suicide.After rediagnosed by 2 physicians-incharge and more than 2 physicians and checked hy one physician-incharge,the cases were collected in patient group.The interview was carried on for the patients with suieidal behavior among all of the survived patients （107 cases） and first grade relatives （14 cases）.The interview （337 cases） and investigation with letter （380 cases） were carried on for the first grade relatives without suicidal behavior.The investigation forrms of 13 dead cases （8 cases of patients, 5 cases of first-grade relatives） were provided and filled-up by one or two first grade relatives.Two researchers interviewed the eases in the control,inquired the first grade relatives and filled up the investigation form of family tree.Single factor analysis was used for all the data and Falconer pattern of polygenetic threshold-value theory was used to estimate hereditary rate and standard error in suicidal behavior.Separation analysis in medical hereditary mathematic method and polygenetic threshold-value theory were applied to discuss the hereditary patterns.MAIN OUTCOME MEASURES：Hereditary effects and patterns of suicidal behavior in unipolar depressed patients.RESULTS：Suicldal risk of unipolar depressed patients（51.30%,59/115）was higher than their first grade relatives （2.58%,19/736） （x^2=283.16,P 〈 0.01）.Suicidal risk of the first grade relatives （2.58%,19/736） of unipolar depressed patients was higher than the control （0.12%,3/2 469）（x^2=50.36,P 〈 0.01）.Suicidal risk of the first grade relatives of the patients with suicidal behavior （3.8%.14/372） was higher than that of the first grade relatives of the patients without suicidal behavior （1.4%,5/363）（x^2=4.14.P〈 0.05）.The weighted average hereditary rate and standard error was （70.16±0.79）% for suicidal behavior in unipolar depression.The predietive morbidity of suicidal behavior in the first grade relatives was 3.1% and the real morbidity was 2.6%,which did not indicate significant difference （u =0.766, P 〉 0.05）.CONCLUSION：Suicidal behavior of unipolar depression presents obvious hereditary effects and its hereditary patterns tally with polygenetie inheritance.