title: Clinical features of patients with dysthymia in a large cohort of Han Chinese women with recurrent major depression.
abstract: BACKGROUND
  Dysthymia is a form of chronic mild depression that has a complex relationship with major depressive disorder (MDD). Here we investigate the role of environmental risk factors, including stressful life events and parenting style, in patients with both MDD and dysthymia. We ask whether these risk factors act in the same way in MDD with and without dysthymia.
  
  
  RESULTS
  We examined the clinical features in 5,950 Han Chinese women with MDD between 30-60 years of age across China. We confirmed earlier results by replicating prior analyses in 3,950 new MDD cases. There were no significant differences between the two data sets. We identified sixteen stressful life events that significantly increase the risk of dysthymia, given the presence of MDD. Low parental warmth, from either mother or father, increases the risk of dysthymia. Highly threatening but short-lived threats (such as rape) are more specific for MDD than dysthymia. While for MDD more severe life events show the largest odds ratio versus controls, this was not seen for cases of MDD with or without dysthymia.
  
  
  CONCLUSIONS
  There are increased rates of stressful life events in MDD with dysthymia, but the impact of life events on susceptibility to dysthymia with MDD differs from that seen for MDD alone. The pattern does not fit a simple dose-response relationship, suggesting that there are moderating factors involved in the relationship between environmental precipitants and the onset of dysthymia. It is possible that severe life events in childhood events index a general susceptibility to chronic depression, rather than acting specifically as risk factors for dysthymia.
authors.affiliation: No. 4 Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, P.R. China.
authors.forename: Wenqing
authors.initials: W
authors.lastname: Wu
authors.affiliation: No. 4 Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, P.R. China.
authors.forename: Zhoubing
authors.initials: Z
authors.lastname: Wang
authors.affiliation: No. 4 Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, P.R. China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Wei
authors.affiliation: No. 4 Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, P.R. China.
authors.forename: Guanghua
authors.initials: G
authors.lastname: Zhang
authors.affiliation: Shanghai Mental Health Center, Shanghai, P.R. China ; Huashan Hospital of Fudan University, Shanghai, P.R. China.
authors.forename: Shenxun
authors.initials: S
authors.lastname: Shi
authors.affiliation: Chinese Traditional Hospital of Zhejiang, Hangzhou, Zhejiang, P.R. China.
authors.forename: Jingfang
authors.initials: J
authors.lastname: Gao
authors.affiliation: No. 1 Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China.
authors.forename: Youhui
authors.initials: Y
authors.lastname: Li
authors.affiliation: Xinhua Hospital of Zhejiang Province, Hangzhou, Zhejiang, P.R. China.
authors.forename: Ming
authors.initials: M
authors.lastname: Tao
authors.affiliation: No. 1 Hospital of Shanxi Medical University, Taiyuan, Shanxi, P.R. China.
authors.forename: Kerang
authors.initials: K
authors.lastname: Zhang
authors.affiliation: ShengJing Hospital of China Medical University, Heping District, Shenyang, Liaoning, P.R. China.
authors.forename: Xumei
authors.initials: X
authors.lastname: Wang
authors.affiliation: No. 1 Hospital of Medical College of Xian Jiaotong University, Xian, Shaanxi, P.R. China.
authors.forename: Chengge
authors.initials: C
authors.lastname: Gao
authors.affiliation: Jilin Brain Hospital, Siping, Jilin, P.R. China.
authors.forename: Lijun
authors.initials: L
authors.lastname: Yang
authors.affiliation: Mental Hospital of Jiangxi Province, Nanchang, Jiangxi, P.R. China.
authors.forename: Kan
authors.initials: K
authors.lastname: Li
authors.affiliation: Xian Mental Health Center, New Qujiang District, Xian, Shaanxi, P.R. China.
authors.forename: Jianguo
authors.initials: J
authors.lastname: Shi
authors.affiliation: Beijing Anding Hospital of Capital University of Medical Sciences, Deshengmen wai, Xicheng District, Beijing, P.R. China.
authors.forename: Gang
authors.initials: G
authors.lastname: Wang
authors.affiliation: Shandong Mental Health Center, Jinan, Shandong, P.R. China.
authors.forename: Lanfen
authors.initials: L
authors.lastname: Liu
authors.affiliation: No. 3 Hospital of Sun Yat-sen University, Tianhe District, Guangzhou, Guangdong, P.R. China.
authors.forename: Jinbei
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Hebei Mental Health Center, Baoding, Hebei, P.R. China.
authors.forename: Bo
authors.initials: B
authors.lastname: Du
authors.affiliation: Chongqing Mental Health Center, Jiangbei District, Chongqing, P.R. China.
authors.forename: Guoqing
authors.initials: G
authors.lastname: Jiang
authors.affiliation: Tianjin Anding Hospital, Hexi District, Tianjin, P.R. China.
authors.forename: Jianhua
authors.initials: J
authors.lastname: Shen
authors.affiliation: The First Hospital of China Medical University, Heping District, Shenyang, Liaoning, P.R. China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Psychiatric Hospital of Henan Province, Xinxiang, Henan, P.R. China.
authors.forename: Wei
authors.initials: W
authors.lastname: Liang
authors.affiliation: Nanjing Brain Hospital, Nanjing, Jiangsu, P.R. China.
authors.forename: Jing
authors.initials: J
authors.lastname: Sun
authors.affiliation: Harbin Medical University, Nangang District, Haerbin, Heilongjiang, P.R. China.
authors.forename: Jian
authors.initials: J
authors.lastname: Hu
authors.affiliation: Shenzhen Kang Ning Hospital, Luohu District, Shenzhen, Guangdong, P.R. China.
authors.forename: Tiebang
authors.initials: T
authors.lastname: Liu
authors.affiliation: First Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China.
authors.forename: Xueyi
authors.initials: X
authors.lastname: Wang
authors.affiliation: Guangzhou Brain Hospital (Guangzhou Psychiatric Hospital), Liwan District, Guangzhou, Guangdong, P.R. China.
authors.forename: Guodong
authors.initials: G
authors.lastname: Miao
authors.affiliation: No. 1 Hospital of Chongqing Medical University, Yuanjiagang,Yuzhong District, Chongqing, P.R. China.
authors.forename: Huaqing
authors.initials: H
authors.lastname: Meng
authors.affiliation: Dalian No. 7 Hospital, Ganjingzi District, Dalian, Liaoning, P.R. China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Li
authors.affiliation: No. 3 Hospital of Heilongjiang Province, Beian, Heilongjiang, P.R. China.
authors.forename: Chunmei
authors.initials: C
authors.lastname: Hu
authors.affiliation: Wuhan Mental Health Center, Wuhan, Hubei, P.R. China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Li
authors.affiliation: Sichuan Mental Health Center, Mianyang, Sichuan, P.R. China.
authors.forename: Guoping
authors.initials: G
authors.lastname: Huang
authors.affiliation: Mental Health Institute of Jining Medical College, Dai Zhuang, Bei Jiao, Jining, Shandong, P.R. China.
authors.forename: Gongying
authors.initials: G
authors.lastname: Li
authors.affiliation: Liaocheng No. 4 Hospital, Liaocheng, Shandong, P.R. China.
authors.forename: Baowei
authors.initials: B
authors.lastname: Ha
authors.affiliation: Mental Health Center of West China Hospital of Sichuan University, Wuhou District, Chengdu, Sichuan, P.R. China.
authors.forename: Hong
authors.initials: H
authors.lastname: Deng
authors.affiliation: Suzhou Guangji Hospital, Suzhou, Jiangsu, P.R. China.
authors.forename: Qiyi
authors.initials: Q
authors.lastname: Mei
authors.affiliation: Anhui Mental Health Center, Hefei, Anhui, P.R. China.
authors.forename: Hui
authors.initials: H
authors.lastname: Zhong
authors.affiliation: Ningbo Kang Ning Hospital, Zhenhai District, Ningbo, Zhejiang, P.R. China.
authors.forename: Shugui
authors.initials: S
authors.lastname: Gao
authors.affiliation: Changchun Mental Hospital, Changchun, Jilin, P.R. China.
authors.forename: Hong
authors.initials: H
authors.lastname: Sang
authors.affiliation: No. 2 Hospital of Lanzhou University, Lanzhou, Gansu, P.R. China.
authors.forename: Yutang
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Fuzhou Psychiatric Hospital, Cangshan District, Fuzhou, Fujian, P.R. China.
authors.forename: Xiang
authors.initials: X
authors.lastname: Fang
authors.affiliation: Harbin No. 1 Special Hospital, Haerbin, Heilongjiang, P.R. China.
authors.forename: Fengyu
authors.initials: F
authors.lastname: Yu
authors.affiliation: Jining Psychiatric Hospital, North Dai Zhuang, Rencheng District, Jining, Shandong, P.R. China.
authors.forename: Donglin
authors.initials: D
authors.lastname: Yang
authors.affiliation: No. 2 Xiangya Hospital of Zhongnan University, Furong District, Changsha, Hunan, P.R. China.
authors.forename: Tieqiao
authors.initials: T
authors.lastname: Liu
authors.affiliation: Xijing Hospital of No. 4 Military Medical University, Xian, Shaanxi, P.R. China.
authors.forename: Yunchun
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Mental Health Center of Shantou University, Shantou, Guangdong, P.R. China.
authors.forename: Xiaohong
authors.initials: X
authors.lastname: Hong
authors.affiliation: Tongji University Hospital, Shanghai, P.R. China.
authors.forename: Wenyuan
authors.initials: W
authors.lastname: Wu
authors.affiliation: Huaian No. 3 Hospital, Huaian, Jiangsu, P.R. China.
authors.forename: Guibing
authors.initials: G
authors.lastname: Chen
authors.affiliation: Huzhou No. 3 Hospital, Huzhou, Zhejiang, P.R. China.
authors.forename: Min
authors.initials: M
authors.lastname: Cai
authors.affiliation: Mudanjiang Psychiatric Hospital of Heilongjiang Province, Xinglong, Mudanjiang, Heilongjiang, P.R. China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Song
authors.affiliation: No. 1 Hospital of Jinan University, Guangzhou, Guangdong, P.R. China.
authors.forename: Jiyang
authors.initials: J
authors.lastname: Pan
authors.affiliation: Qingdao Mental Health Center, Shibei District, Qingdao, Shandong, P.R. China.
authors.forename: Jicheng
authors.initials: J
authors.lastname: Dong
authors.affiliation: Guangxi Longquanshan Hospital, Yufeng District, Liuzhou, P.R. China.
authors.forename: Runde
authors.initials: R
authors.lastname: Pan
authors.affiliation: Daqing No. 3 Hospital of Heilongjiang Province, Ranghulu District, Daqing, Heilongjiang, P.R. China.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Tangshan No. 5 Hospital, Lunan District, Tangshan, Hebei, P.R. China.
authors.forename: Zhenming
authors.initials: Z
authors.lastname: Shen
authors.affiliation: Anshan Psychiatric Rehabilitation Hospital, Lishan District, Anshan, Liaoning, P.R. China.
authors.forename: Zhengrong
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Weihai Mental Health Center, Qilu Avenue, ETDZ, Weihai, Shandong, P.R. China.
authors.forename: Danhua
authors.initials: D
authors.lastname: Gu
authors.affiliation: Renmin Hospital of Wuhan University, Wuchang District, Wuhan, Hubei, P.R. China.
authors.forename: Xiaoping
authors.initials: X
authors.lastname: Wang
authors.affiliation: Tianjin First Center Hospital, Hedong District, Tianjin, P.R. China.
authors.forename: Xiaojuan
authors.initials: X
authors.lastname: Liu
authors.affiliation: Hainan Anning Hospital, Haikou, Hainan, P.R. China.
authors.forename: Qiwen
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: Wellcome Trust Centre for Human Genetics, Oxford, United Kingdom.
authors.forename: Yihan
authors.initials: Y
authors.lastname: Li
authors.affiliation: Clinical Trial Service Unit, Richard Doll Building, Oxford, United Kingdom.
authors.forename: Yiping
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia, United States of America.
authors.forename: Kenneth S
authors.initials: KS
authors.lastname: Kendler
authors.affiliation: Wellcome Trust Centre for Human Genetics, Oxford, United Kingdom.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Flint
authors.affiliation: No. 4 Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, P.R. China.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Zhang
mesh_terms: D000328:Adult; D044466:Asian People; D002681:China; D015331:Cohort Studies; D003865:Major Depressive Disorder / Q000150:complications*; D004198:Disease Susceptibility; D019263:Dysthymic Disorder / Q000150:complications* / Q000175:diagnosis; D004777:Environment; D005260:Female; D006801:Humans; D008016:Life Change Events; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D011795:Surveys and Questionnaires