Wenqing Wu, No. 4 Affiliated Hospital of Jiangsu University
Zhoubing Wang, No. 4 Affiliated Hospital of Jiangsu University
Yan Wei, No. 4 Affiliated Hospital of Jiangsu University
Guanghua Zhang, No. 4 Affiliated Hospital of Jiangsu University
Shenxun Shi, Huashan Hospital of Fudan University
Jingfang Gao, Chinese Traditional Hospital of Zhejiang
Youhui Li, Hospital of Zhengzhou University
Ming Tao, Xinhua Hospital of Zhejiang Province
Kerang Zhang, Hospital of Shanxi Medical University
Xumei Wang, ShengJing Hospital of China Medical University
Chengge Gao, Hospital of Medical College of Xian Jiaotong University
Lijun Yang, Jilin Brain Hospital
Kan Li, Mental Hospital of Jiangxi Province
Jianguo Shi, Xian Mental Health Center
Gang Wang, Capital Medical University
Lanfen Liu, Shandong Mental Health Center
Jinbei Zhang, Sun Yat-sen University
Bo Du, Hebei Mental Health Center
Guoqing Jiang, Chongqing Mental Health Center
Jianhua Shen, Tianjin Anding Hospital
Ying Liu, The First Hospital of China Medical University
Wei Liang, Psychiatric Hospital of Henan Province
Jing Sun, Nanjing Brain Hospital
Jian Hu, Harbin Medical University
Tiebang Liu, Shenzhen Kangning Hospital
Xueyi Wang, The First Hospital of Hebei Medical University
Guodong Miao, Guangzhou Brain Hospital Guangzhou
Huaqing Meng, Hospital of Chongqing Medical University
Yi Li, Dalian No. 7 Hospital
Guoping Huang, Sichuan Mental Health Center
Gongying Li, Mental Health Institute of Jining Medical College
Baowei Ha, Liaocheng No. 4 Hospital
Hong Deng, Mental Health Center of West China Hospital of Sichuan University
Qiyi Mei, Suzhou Guangji Hospital
Hui Zhong, Anhui Mental Health Center
Shugui Gao, Ningbo Kang Ning Hospital
Hong Sang, Changchun Mental Hospital
Yutang Zhang, No. 2 Hospital of Lanzhou University
Xiang Fang, Fuzhou Psychiatric Hospital
Fengyu Yu, Harbin No. 1 Special Hospital
Donglin Yang, Jining Psychiatric Hospital
Tieqiao Liu, No. 2 Xiangya Hospital of Zhongnan University
Yunchun Chen, Xijing Hospital of No. 4 Military Medical University
Xiaohong Hong, Mental Health Center of Shantou University
Wenyuan Wu, Tongji University Hospital
Guibing Chen, Huaian No. 3 Hospital
Min Cai, Huzhou No. 3 Hospital
Yan Song, Mudanjiang Psychiatric Hospital of Heilongjiang Province
Jiyang Pan, No. 1 Hospital of Jinan University
Jicheng Dong, Qingdao Mental Health Center
Runde Pan, Guangxi Longquanshan Hospital
Wei Zhang, Daqing No. 3 Hospital of Heilongjiang Province
Zhenming Shen, Tangshan No. 5 Hospital
Zhengrong Liu, Anshan Psychiatric Rehabilitation Hospital
Danhua Gu, Weihai Mental Health Center
Xiaoping Wang, Renmin Hospital of Wuhan University
Xiaojuan Liu, Tianjin First Center Hospital
Qiwen Zhang, Hainan Anning Hospital
Yihan Li, Wellcome Trust Centre for Human Genetics
Yiping Chen, Clinical Trial Service Unit
Kenneth S. Kendler, Virginia Commonwealth UniversityFollow
Jonathan Flint, Wellcome Trust Centre for Human Genetics
Zhen Zhang, Jiangsu University

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November 2014



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.


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.


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.


Copyright: © 2013 Wu et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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VCU Psychiatry Publications