Clinical Features and Familial Aggregation of Social Relationships in Major Depressive and Bipolar Disorders in Southern Taiwan

台灣南部地區重鬱症與雙極症之表現型特徵與社交關係的家族聚集現象

10.6288/TJPH2010-29-02-10

賴穎婕(Yin-Chieh Lai)；呂明坤(Ming-Kun Lu)；楊延光(Yen-Kuang Yang)；林進嘉(Jin-Jia Lin)；譚宏斌(Hung-Pin Tan)；陳為堅(Wei-Jen Chen)；陸汝斌(Ru-Bagd Lu)；郭柏秀(Po-Hsiu Kuo)

重鬱症 ； 雙極症 ； 家族聚集 ； 家族研究 ； Major Depressive Disorder ； Bipolar disorder ； Familial Aggregation ； Family Study

台灣公共衛生雜誌

29卷2期（2010 / 04 / 01）

169 - 182

英文

目標：探討台灣南部地區重鬱症與雙極症之人口學特徵與症狀分佈情形，及社交關係的家族聚集現象。方法：透過家族研究設計收取290位個案（127位雙極症第一型，43.8%；84位雙極症第二型，29.0%；79位重鬱症患者，27.2%）及399位家屬。透過組合性國際診斷會談問卷(CIDI)收集人口學變項及臨床表徵資料。重鬱症與雙鬱症患者在社交關係的家族聚集由混和模式(mixed models)、組內相關係數(intraclass correlation coefficient)評估。結果：重鬱症中女性為男性兩倍，雙極症中男比女約一比一。重鬱症患者結婚率較雙極症高。兩種患者中九成社經地位較低。雙極症的發病年齡較重鬱症早且發作次數頻繁。兩種患者的功能損傷越嚴重則越少與朋友聯絡，且對於親屬與朋友的社交依賴存在家族聚集現象。結論：重鬱症與雙極症存在不同的臨床特性且在社交關係有家族聚集現象。

Objectives: To investigate the demographic features and the distribution of symptoms for major depressive disorder (MDD), bipolar disorder type I (BPI), and bipolar disorder type II (BPII) families in Southern Taiwan, and to evaluate the familial aggregation of social relationships for the three diagnoses. Methods: A total of 290 probands (127, 43.8% BPI; 84, 29.0% BPII; and 79, 27.2% MDD) and 399 relatives participated in this study. Participants were interviewed by well-trained interviewers using the Composite International Diagnostic Interview (CIDI) in order to collect data about diagnosis, demographic and clinical features. Familial aggregation of social relationships were evaluated by the use of mixed models and intraclass correlation coefficients. Results: The female to male ratio was two to one in MDD and one to one in BPD. A higher proportion of MDD patients were married than were BPD patients. About ninety percent of all mood disorder patients had low socioeconomic status. Patients with BPD had an earlier age of onset and more depressive/manic episodes than did MDD patients. Probands with more severe impairments tended to have fewer contacts with friends. A familial aggregation of social dependence was observed in our sample. Conclusions: MDD and BPD patients have different clinical characteristics and familial aggregation of social relationships.

1. Bearden, CE,Glahn, DC,Monkul, ES(2006).Patterns of memory impairment in bipolar disorder and unipolar major depression.Psychiatry Res,142,139-150.
2. Benazzi, F(2007).Bipolar disorder-focus on bipolar II disorderand mixed depression.Lancet,369,935-945.
3. Brugha, TS,Wing, JK,Brewin, CR,MacCarthy, B,Lesage, A(1993).The relationship of social network deficits with deficits in social functioning in longterm psychiatric disorders.Soc Psychiatry Psychiatr Epidemiol,28,218-224.
4. Bureau of Health Promotion, Department of Health R.O.C.(Taiwan)(2002).National Health Survey.Taipei, Taiwan:Bureau of Health Promotion.
5. Chien, IC,Chou, YJ,Lin, CH,Bih, SH,Chou, P(2004).Prevalence of psychiatric disorders among National Health Insurance enrollees in Taiwan.Psychiatr Serv,55,691-697.
6. Eaton, WW,Shao, H,Nestadt, G,Lee, HB,Bienvenu, OJ,Zandi, P(2008).Population-based study of first onset and chronicity in major depressive disorder.Arch Gen Psychiatry,65,513-520.
7. Endicott, J,Spitzer, RL(1978).A diagnostic interview: the schedule for affective disorders and schizophrenia.Arch Gen Psychiatry,35,837-844.
8. Gazalle, FK,Frey, BN,Hallal, PC(2007).Mismatch between self-reported quality of life and functional assessment in acute mania: a matter of unawareness of illness?.J Affect Disord,103,247-252.
9. Hirschfeld, RM,Montgomery, SA,Keller, MB(2000).Social functioning in depression: a review.J Clin Psychiatry,61,268-275.
10. Janssen, SM,Chessa, AG,Murre, JM(2006).Memory for time: how people date events.Mem Cognit,34,138-147.
11. Kamat, SA,Rajagopalan, K,Pethick, N,Willey, V,Bullano, M,Hassan, M(2008).Prevalence and humanistic impact of potential misdiagnosis of bipolar disorder among patients with major depressive disorder in a commercially insured population.J Manag Care Pharm,14,631-642.
12. Kessler, RC,Ustun, TB(2004).The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite InternationalDiagnostic Interview (CIDI).Int J Methods Psychiatr Res,13,93-121.
13. Kiejna, A,Rymaszewska, J,Hadrys, T,Suwalska, A,Lojko, D,Rybakowski, JK(2006).Bipolar or unipolar? the question for clinicians and researchers.J Affect Disord,93,177-183.
14. Kuehner, C.(2003).Gender differences in unipolar depression: an update of epidemiological findings and possible explanations.Acta Psychiatr Scand,108,163-174.
15. Modabernia, MJ,Tehrani, HS,Fallahi, M,Shirazi, M,Modabbernia, AH(2008).Prevalence of depressive disorders in Rasht, Iran: a community based study.Clin Pract Epidemol Ment Health,4,20.
16. Moussavi, S,Chatterji, S,Verdes, E,Tandon, A,Patel, V,Ustun, B(2007).Depression, chronic diseases, and decrements in health: results from the World Health Surveys.Lancet,370,851-858.
17. Muthen, LK,Muthen, BO(1998).The Comprehensive Modeling Program for Applied Researchers..Los Angeles:Muthen and Muthen.
18. National Statistics (Taiwan)(2008).National Accounts Yearbook.Taipei:China Statistics Association.
19. Oswald, P,Souery, D,Kasper, S(2007).Current issues in bipolar disorder: a critical review.Eur Neuropsychopharmacol,17,687-695.
20. Perlis, RH,Miyahara, S,Marangell, LB(2004).Longterm implications of early onset in bipolar disorder: data from the first 1000 participants in the systematic treatment enhancement program for bipolar disorder (STEP-BD).Biol Psychiatry,55,875-881.
21. Poutanen, O,Koivisto, AM,Mattila, A,Joukamaa, M,Salokangas, RK(2009).Gender differences in the symptoms of major depression and in the level of social functioning in public primary care patients.Eur J Gen Pract,15,161-167.
22. Rosa, AR,Reinares, M,Franco, C(2009).Clinical predictors of functional outcome of bipolar patients in remission.Bipolar Disord,11,401-409.
23. SAS Institute Inc.(2003).SAS/STAT User's Guide.Cary, NC:SAS Institute Inc..
24. Saunders, EH,Scott, LJ,McInnis, MG,Burmeister, M(2008).Familiality and diagnostic patterns of subphenotypes in the National Institutes of Mental Health bipolar sample.Am J Med Genet B Neuropsychiatr Genet,147B,18-26.
25. Schulze, TG,Hedeker, D,Zandi, P,Rietschel, M,McMahon, FJ(2006).What is familial about familial bipolar disorder? Resemblance among relatives across a broad spectrum of phenotypic characteristics.Arch Gen Psychiatry,63,1368-1376.
26. Smolle, JW,Finn, CT(2003).Family, twin, and adoption studies of bipolar disorder.Am J Med Genet C Semin Med Genet,123C,48-58.
27. Suominen, K,Mantere, O,Valtonen, H(2007).Early age at onset of bipolar disorder is associated with more severe clinical features but delayed treatment seeking.Bipolar Disord,9,698-705.
28. Weissman, MM,Bland, RC,Canino, GJ(1996).Crossnational epidemiology of major depression and bipolar disorder.JAMA,276,293-299.
29. WHO(2008).The Global Burden of Disease : 2004 Update.Geneva:WHO.
30. WHO (ed.)(2000).Global Program on Evidence for Health Policy (GPE). Global Burden of Disease 2000.Geneva:WHO.