هراس خاص و افسردگی همزمان: نگاهی دقیقتر به بررسی داده های ملی همبودی

Previous studies examining the relationship between specific phobia and major depression have reported mixed findings. The results of some studies have suggested that specific phobia is associated with a higher prevalence of comorbid depression, whereas others have found no association. The purpose of this study was to further examine whether specific phobia is an independent contributor to major depression by using data from the National Comorbidity Survey, a household probability sample of adults (n = 5877) aged 15 to 54 years in the United States. After adjusting for demographic differences and comorbid mental disorders, multiple logistic regression analyses confirmed that specific phobia remains positively associated with comorbid depression (odds ratio, 1.9; 95% confidence interval, 1.6-2.4). Additional analysis found this relationship to be specific to individuals with a fear of heights, animals, and closed spaces, as well as those endorsing at least 2 irrational fears. These results suggest that the types and number of fears play an important role in the probability of lifetime depression.

It is well known that specific phobia and depression are highly comorbid disorders, where the onset of specific phobia precedes that of depression in most cases [1] and [2]. Several studies have closely examined the relationship between specific phobia and depression, but they have reported mixed findings. One study was based on the Epidemiologic Catchment Area (ECA) survey of an adult community sample, which found specific phobia to be an independent predictor of major depression [3]. However, reports of 2 prospective, longitudinal studies did not find such a link between specific phobia and depression [4] and [5]. In the National Comorbidity Survey (NCS), specific phobia has also been associated with depression, but the nature of this relationship has not been well characterized [6]. Specifically, it is not clear if the association remains significant after adjusting for potential confounding psychiatric disorders. In addition, it is not known to what extent the risk of depression is related to the types (eg, heights, animals) and numbers of fears or phobias. The purpose of this study was to determine if the link between specific phobia and depression remains significant after adjusting for demographic and comorbid psychiatric illnesses. If a positive association exists, it would also be interesting to see if this association is specific to a particular type and number of fears. Thus, our second goal is to look at the contributions of the specific types and numbers of irrational fears to lifetime diagnosis of depression. Although it would also be helpful to do a similar analysis with respect to types and numbers of phobias, this was not possible in the existing sample. The reason is that for individuals who endorsed more than one fear, the NCS diagnostic instrument did not establish which fears accounted for the phobia diagnosis.1 Examining irrational fears may give a crude approximation of how the corresponding types and numbers of phobias relate to depression. 2. Methods The NCS is based on a national probability sample (n = 5877) of individuals aged 15 to 54 years living in the community in the United States. Fieldwork was carried out between September 1990 and February 1992 with a response rate of 82.4%. A full description of study methodology is described in detail elsewhere [7].