一项关于心境恶劣终身患病率的研究报告:男性约 2%,女性约 4%。[2]Weissman MM, Leaf PJ, Bruce ML, et al. The epidemiology of dysthymia in five communities: rates, risks, comorbidity, and treatment. Am J Psychiatry. 1988;145:815-819.http://www.ncbi.nlm.nih.gov/pubmed/3381924?tool=bestpractice.com另一项研究报告终身患病率大约为 6%,女性比男性更容易发病。[3]Kessler RC, McGonagle KA, Zhao S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry. 1994;51:8-19.http://www.ncbi.nlm.nih.gov/pubmed/8279933?tool=bestpractice.com美国国家共患研究(The US National Comorbidity Replication Study)报告,一般人群心境恶劣障碍 12 个月的患病率为 1.5%,而终身患病率为 2.5%。[4]Kessler RC, Berglund PA, Demler O, et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62:593-602.http://archpsyc.ama-assn.org/cgi/content/full/62/6/593http://www.ncbi.nlm.nih.gov/pubmed/15939837?tool=bestpractice.com[5]Kessler RC, Chiu WT, Demler O, et al. Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62:617-627.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2847357/?tool=pubmedhttp://www.ncbi.nlm.nih.gov/pubmed/15939839?tool=bestpractice.com
在持续性抑郁症的 4 个亚型中,慢性重性抑郁症 (MDD) 可能比心境恶劣更常见。一项关于酒精及相关疾病流行病学数据库的国内流行病学调查 (National Epidemiologic Survey on Alcohol and Related Conditions, NESARC)研究显示 慢性 MDD 12 个月和终身患病率(分别为 1.5% 和 3.0%)比心境恶劣(分别为 0.5% 和 0.9%)更高。[6]Blanco C, Okuda M, Markowitz JC, et al. The epidemiology of chronic major depressive disorder and dysthymic disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2010;71:1645-1656.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3202750/http://www.ncbi.nlm.nih.gov/pubmed/21190638?tool=bestpractice.com大多数患者都有慢性抑郁的早期发作。此外也提出了中年发病的形式。[7]Devanand DP, Nobler MS, Singer T, et al. Is dysthymia a different disorder in the elderly? Am J Psychiatry. 1994;151:1592-1599.http://www.ncbi.nlm.nih.gov/pubmed/7943446?tool=bestpractice.com老年发作的慢性抑郁可能是受累于血管性抑郁。[8]Devanand DP, Adorno E, Cheng J, et al. Late onset dysthymic disorder and major depression differ from early onset dysthymic disorder and major depression in elderly outpatients. J Affect Disord. 2004;78:259-267.http://www.ncbi.nlm.nih.gov/pubmed/15013252?tool=bestpractice.com
大多数持续性抑郁症患者共患其他精神疾病,例如,焦虑障碍和物质滥用。大约 80% 的持续性抑郁症患者会在某个时点出现重性抑郁发作,而且可能重复发作(“双重抑郁”)。[9]Kovacs M, Akiskal HS, Gatsonis C, et al. Childhood-onset dysthymic disorder. Clinical features and prospective naturalistic outcome. Arch Gen Psychiatry. 1994;51:365-374.http://www.ncbi.nlm.nih.gov/pubmed/8179460?tool=bestpractice.com[10]Klein DN, Nordern KA, Ferro T, et al. Thirty-month naturalistic follow-up study of early onset dysthymic disorder: course, diagnostic stability, and prediction of outcome. J Abnorm Psychol. 1998;107:338-348.http://www.ncbi.nlm.nih.gov/pubmed/9604563?tool=bestpractice.com[11]Klein DN, Schwartz JE, Rose S, et al. Five-year course and outcome of dysthymic disorder: a prospective, naturalistic follow-up study. Am J Psychiatry. 2000;157:931-939.http://www.ncbi.nlm.nih.gov/pubmed/10831473?tool=bestpractice.com[12]Keller MB, Shapiro RW. Double depression: superimposition of acute depressive episodes on chronic depressive disorders. Am J Psychiatry. 1982;139:438-442.http://www.ncbi.nlm.nih.gov/pubmed/7065289?tool=bestpractice.com慢性抑郁在所有单相心境障碍中大约占30%。[13]Keller MB, Klein DN, Hirschfeld RM, et al. Results of the DSM-IV mood disorders field trial. Am J Psychiatry. 1995;152:843-849.http://www.ncbi.nlm.nih.gov/pubmed/7755112?tool=bestpractice.com心理疾病发病率和医疗过度使用与持续性抑郁症有密切相关。[14]Friedman RA, Markowitz JC, Parides M, et al. Acute response of social functioning in dysthymic patients with desipramine. J Affect Disord. 1995;34:85-88.http://www.ncbi.nlm.nih.gov/pubmed/7665809?tool=bestpractice.com[15]Dunner DL. Dysthymia and double depression. Int Rev Psychiatry. 2005;17:3-8.http://www.ncbi.nlm.nih.gov/pubmed/16194766?tool=bestpractice.com[16]Yang T, Dunner DL. Differential subtyping of depression. Depress Anxiety. 2001;13:11-17.http://www.ncbi.nlm.nih.gov/pubmed/11233455?tool=bestpractice.com[17]Howland RH. Chronic depression. Hosp Community Psychiatry. 1993;44:633-639.http://www.ncbi.nlm.nih.gov/pubmed/8354502?tool=bestpractice.com[18]Angst J, Gamma A, Rössler W, et al. Long-term depression versus episodic major depression: results from the prospective Zurich study of a community sample. J Affect Dis. 2009;115:112-121.http://www.ncbi.nlm.nih.gov/pubmed/18973954?tool=bestpractice.com[19]Hellerstein DJ, Agosti V, Bosi M, et al. Impairment in psychosocial functioning associated with dysthymic disorder in the NESARC study. J Affect Disord. 2010;127:84-88.http://www.ncbi.nlm.nih.gov/pubmed/20471093?tool=bestpractice.com