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Adaptive and non-adaptive models of depression: A comparison using register data on antidepressant medication during divorce

机译:自适应和非自适应抑郁模型:离婚期间使用抗抑郁药物的注册数据进行比较

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摘要

Divorce is associated with an increased probability of a depressive episode, but the causation of events remains unclear. Adaptive models of depression propose that depression is a social strategy in part, whereas non-adaptive models tend to propose a diathesis-stress mechanism. We compare an adaptive evolutionary model of depression to three alternative non-adaptive models with respect to their ability to explain the temporal pattern of depression around the time of divorce. Register-based data (304,112 individuals drawn from a random sample of 11% of Finnish people) on antidepressant purchases is used as a proxy for depression. This proxy affords an unprecedented temporal resolution (a 3-monthly prevalence estimates over 10 years) without any bias from non-compliance, and it can be linked with underlying episodes via a statistical model. The evolutionary-adaptation model (all time periods with risk of divorce are depressogenic) was the best quantitative description of the data. The non-adaptive stress-relief model (period before divorce is depressogenic and period afterwards is not) provided the second best quantitative description of the data. The peak-stress model (periods before and after divorce can be depressogenic) fit the data less well, and the stress-induction model (period following divorce is depressogenic and the preceding period is not) did not fit the data at all. The evolutionary model was the most detailed mechanistic description of the divorce-depression link among the models, and the best fit in terms of predicted curvature; thus, it offers most rigorous hypotheses for further study. The stress-relief model also fit very well and was the best model in a sensitivity analysis, encouraging development of more mechanistic models for that hypothesis.
机译:离婚与抑郁发作的可能性增加有关,但事件的因果关系仍不清楚。抑郁症的适应性模型提出,抑郁症在某种程度上是一种社会策略,而非适应性模型则倾向于提出一种素质-压力机制。我们将抑郁症的适应性进化模型与三个替代性非适应性模型进行比较,以解释离婚时抑郁症的时间模式。基于登记册的数据(从11%的芬兰人中随机抽取的304112个人)用于购买抗抑郁药,可以用来代替抑郁症。该代理提供了前所未有的时间分辨率(10年中每3个月的患病率估算值),而不会因违规而产生任何偏差,并且可以通过统计模型将其与基础事件关联。进化适应模型(所有有离婚风险的时间段都是抑郁的)是数据的最佳定量描述。非自适应应力释放模型(离婚前的时期是抑郁的时期,离婚后的时期不是抑郁的时期)提供了数据的第二最佳定量描述。峰值应激模型(离婚前后的时期可能会导致抑郁)与数据的拟合不太好,而压力诱导模型(离婚后的时期则导致抑郁,而上一时期则不成立)根本无法拟合数据。进化模型是模型之间对离婚-抑郁联系的最详细的机械描述,并且在预测曲率方面最合适;因此,它提供了最严格的假设以供进一步研究。应力消除模型也非常合适,并且是敏感性分析中的最佳模型,这鼓励了针对该假设的更多机械模型的开发。

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