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一篇发表在国际顶尖杂志 nature review上的文章，从 MDD 的流行病学、生物学和环境机制、管理和预防等方面进行了介绍，并概述了新兴研究以及 MDD 对日常功能和生活质量的影响。
世界卫生组织调查显示全球抑郁症患病率约10%[2]，但MDD患病率因研究设计和方法差异显著，可能低估真实值。前瞻研究揭示 MDD 终生患病率超 30% [3]。国家间 MDD 患病率各异，高收入与低收入国家略不同（图1），格陵兰岛和希腊最高，东南亚、大洋洲国家（如越南、所罗门群岛）较低（图2）。然而，受文化差异和方法学影响，这些差异是否“真实”尚待考究[1,4]。
图1 MDD全球不同地区患病率随时间变化
图2 MDD流行率的地区分布图
此外，MDD的患病率在全世界女性中几乎是男性的两倍，并且在整个成年期保持相对稳定[1,3]。患病率的性别差异可归因于生物心理社会因素的差异，包括生物和发育因素（如遗传和荷尔蒙差异）、心理因素（自我意识情绪的差异）和环境因素（如社会性别不平等）[5]。
MDD 通常出现在成年早期， MDD首次发病集中在 20-25 岁左右[5]。在社区调查中，抑郁发作的中位持续时间为 2-6 个月，超过70% 的抑郁发作在12个月内消退[6]，但许多人仍处于缓解期。相比之下，在初级和二级精神卫生保健机构的研究中，大约 34-48% 的患者疾病持续时间超过 12 个月，且复发率非常高（在一些研究中高达 85%）[5]。抑郁严重程度越重、治疗前抑郁持续时间越长，可能导致抑郁发作持续时间也会更长。而抑郁发作前，身心功能较好的患者，可能持续时间更短[6]。
与一般人群相比，MDD 患者的并发症发生率更高[7]。自杀也是导致死亡率上升的一个关键因素。与无MDD患者相比，自杀死亡风险增加近20倍（95%CI 12.2–32.0）[8]。MDD 患者产生自杀意念、计划和企图的风险也更高[8]。
MDD是一种复杂的疾病；病因因素以及分子和细胞机制都与MDD的发生和持续有关。病因因素包括遗传和环境因素，发病机制包括大脑结构和功能、炎症、肠-脑轴和下丘脑-垂体-肾上腺（HPA）轴的改变。
MDD与自主神经系统（在应激条件下交感神经张力较高）、免疫系统和HPA轴的慢性过度活跃有关（图3）.这些系统的失调是相互关联的，并且经常在MDD中同时发生[8,9]并可能导致 MDD 患者体细胞并发症的增加。
图3 MDD发病有关的生物学机制
HPA轴是一个主要的应激反应系统，能够适应生理和心理刺激，主要组成部分是下丘脑的室旁核，垂体的前叶和肾上腺皮质。HPA轴的异常活动是MDD研究和证实最多的生物学特征之一。
MDD 诊断的主要方法使用 DSM-5-TR 和 ICD-11中的操作诊断标准[18]。评估疑似 MDD 患者在过去 2 周内是否存在 MDD 症状。
抑郁症状在一般人群中呈连续性（图4）。在将这些症状区分为有无临床表现会比较困难。明确的MDD诊断缺乏金标准，阈值以下的抑郁状态并不一定等同于完全的健康，并且这些抑郁状态可能与临床上重要的功能障碍有关。此外，这些症状是未来 MDD 诊断的危险因素，在一些研究中，估计有 3.8-18.9% 的阈值下个体在 1-3 年内发展为 MDD[19,20]。同样，对症状的治疗可以有效地改善抑郁症状和生活质量。
图4 PHQ-9总分在人群中的分布
MDD的预防主要分为三种：普遍预防、选择性预防（针对高危人群）和指示性预防（针对阈值下症状人群）。研究显示，对高危人群进行选择性预防，使一年内抑郁症发病率降低19%（95%CI 9-28%）[22]。学校预防计划中，针对高危人群的干预效果更佳。部分研究还证实，高风险抑郁症状青少年的初始发作率在有效心理干预后有所下降，并在葡萄牙一项为期24个月的青少年队列研究中得到重复验证[23]。
治疗差距（无法获得治疗的精神障碍患者的百分比）在高收入国家约为35-50%，而在低收入和中等收入国家高达85%。MDD患者的治疗机会和充分性也反映出这种差异[26]。原因之一是精神卫生工作者数量的悬殊：低收入国家每10万人不足1.4名，而高收入国家则超过62名[27]。在治疗供给上，71%的高收入国家超过75%的初级保健中心提供药物和社会心理干预，而中低收入国家这一比例仅为13%。政府财政对精神卫生保健的支持同样悬殊，中低收入国家人均仅0.37美元，而高收入国家则高达52.73美元[27]。
可用的心理治疗类型
多项研究证实，运动能显著改善抑郁症状[29]。每周2-3次、每次45-60分钟的中等强度有氧运动或阻力训练效果最佳[30]。在小组中监督运动，并依个人喜好调整，可提高运动依从性。
对于MDD，除了运动，其他生活方式干预也至关重要，如放松、工作调整、改善睡眠、正念训练等。同时，优化饮食、多接触绿色空间、戒烟和减少孤独感也有助减轻抑郁症状[30]。这些生活方式调整还有益于改善MDD患者的代谢和心肺健康，进而应对相关并发症[31]。
（正念训练和运动对抑郁症改善有效）
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