Silberg Judy, Rutter Michael, D'Onofrio Brian, Eaves Lindon
Department of Human Genetics, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond 23298-0003, USA.
J Child Psychol Psychiatry. 2003 Jul;44(5):664-76. doi: 10.1111/1469-7610.00153.
The present study was undertaken with the goal of understanding the causes of association between substance use and both conduct disturbance (CD) and depression in adolescent boys and girls.
Multivariate genetic structural equation models were fitted to multi-informant, multi-wave, longitudinal data collected in extensive home interviews with parents and children with respect to 307 MZ male, 392 MZ female, 185 DZ male, and 187 DZ female, same-sex twin pairs aged 12-17 years from the Virginia Twin Study of Adolescent Behavioral Development (VTSABD).
Although conduct disturbance and depression were moderately associated with substance use, the pattern of genetic and environmental risk differed for males and females and across the two disorders. Genetic factors were predominant in girls' substance use whereas boys' use was mediated primarily by shared environmental factors reflecting family dysfunction and deviant peers. The patterns of correlations across the two waves of the study were consistent with conduct disturbance leading to substance use in both males and females, but depression leading to smoking, drug use and, to a lesser extent, alcohol use in girls.
The comorbidity between substance use and depression, and between substance use and conduct disturbance in childhood/adolescence, probably reflects rather different mediating mechanisms--as well as a different time frame, with conduct disturbance preceding substance use but depression following it. In both, the co-occurrence partially reflected a shared liability but, in girls, genetic influences played an important role in the comorbidity involving depression, whereas in both sexes (but especially in boys) environmental factors played a substantial role. The extent to which these differences reflect genuine differences in the causal mechanisms underlying substance use and CD/depression in boys and girls revealed in the present analysis awaits replication from studies of other general population samples.
本研究旨在了解青少年男孩和女孩中物质使用与品行障碍（CD）及抑郁之间关联的原因。
对弗吉尼亚青少年行为发展双生子研究（VTSABD）中12至17岁的307对同卵男性、392对同卵女性、185对异卵男性和187对异卵女性同性双生子进行了广泛的家庭访谈，收集了多信息源、多波次的纵向数据，并拟合了多变量遗传结构方程模型。
尽管品行障碍和抑郁与物质使用存在中度关联，但男性和女性以及这两种障碍的遗传和环境风险模式有所不同。遗传因素在女孩的物质使用中占主导地位，而男孩的物质使用主要由反映家庭功能失调和不良同伴的共同环境因素介导。研究两波次间的相关模式与品行障碍导致男性和女性物质使用一致，但抑郁导致女孩吸烟、吸毒以及在较小程度上导致饮酒。
儿童期/青少年期物质使用与抑郁之间以及物质使用与品行障碍之间的共病现象，可能反映了相当不同的中介机制——以及不同的时间框架，品行障碍先于物质使用出现，而抑郁则在其后。在这两种情况中，共病部分反映了共同的易感性，但在女孩中，遗传影响在涉及抑郁的共病中起重要作用，而在两性（尤其是男孩）中，环境因素起了很大作用。本分析中揭示的这些差异在多大程度上反映了男孩和女孩物质使用及CD/抑郁潜在因果机制的真正差异，有待其他一般人群样本研究的重复验证。
