Costello E Jane, Mustillo Sarah, Erkanli Alaattin, Keeler Gordon, Angold Adrian
Department of Psychiatry and Behavioral Sciences, Duke University Medical School, Durham, NC 27710, USA.
Arch Gen Psychiatry. 2003 Aug;60(8):837-44. doi: 10.1001/archpsyc.60.8.837.
This longitudinal community study assessed the prevalence and development of psychiatric disorders from age 9 through 16 years and examined homotypic and heterotypic continuity.
A representative population sample of 1420 children aged 9 to 13 years at intake were assessed annually for DSM-IV disorders until age 16 years.
Although 3-month prevalence of any disorder averaged 13.3% (95% confidence interval [CI], 11.7%-15.0%), during the study period 36.7% of participants (31% of girls and 42% of boys) had at least 1 psychiatric disorder. Some disorders (social anxiety, panic, depression, and substance abuse) increased in prevalence, whereas others, including separation anxiety disorder and attention-deficit/hyperactivity disorder (ADHD), decreased. Lagged analyses showed that children with a history of psychiatric disorder were 3 times more likely than those with no previous disorder to have a diagnosis at any subsequent wave (odds ratio, 3.7; 95% CI, 2.9-4.9; P<.001). Risk from a previous diagnosis was high among both girls and boys, but it was significantly higher among girls. Continuity of the same disorder (homotypic) was significant for all disorders except specific phobias. Continuity from one diagnosis to another (heterotypic) was significant from depression to anxiety and anxiety to depression, from ADHD to oppositional defiant disorder, and from anxiety and conduct disorder to substance abuse. Almost all the heterotypic continuity was seen in girls.
The risk of having at least 1 psychiatric disorder by age 16 years is much higher than point estimates would suggest. Concurrent comorbidity and homotypic and heterotypic continuity are more marked in girls than in boys.
这项纵向社区研究评估了9岁至16岁儿童精神障碍的患病率及其发展情况，并研究了同型和异型连续性。
对1420名9至13岁的儿童进行代表性抽样，在其16岁之前每年评估其是否患有《精神疾病诊断与统计手册》第四版（DSM-IV）中的精神障碍。
虽然任何精神障碍的3个月患病率平均为13.3%（95%置信区间[CI]，11.7%-15.0%），但在研究期间，36.7%的参与者（31%的女孩和42%的男孩）至少患有一种精神障碍。一些精神障碍（社交焦虑症、恐慌症、抑郁症和药物滥用）的患病率有所上升，而其他一些障碍，包括分离焦虑症和注意力缺陷/多动障碍（ADHD）的患病率则有所下降。滞后分析表明，有精神障碍病史的儿童在随后任何一个阶段被诊断出患有精神障碍的可能性是无病史儿童的3倍（优势比，3.7；95%CI，2.9-4.9；P<0.001）。既往诊断带来的风险在男孩和女孩中都很高，但在女孩中显著更高。除特定恐惧症外，所有精神障碍的同型（同一障碍）连续性都很显著。从一种诊断到另一种诊断的异型连续性在从抑郁症到焦虑症、从焦虑症到抑郁症、从ADHD到对立违抗障碍，以及从焦虑症和品行障碍到药物滥用方面都很显著。几乎所有的异型连续性都出现在女孩中。
到16岁时至少患有一种精神障碍的风险远高于点估计值所显示的风险。同时存在的共病以及同型和异型连续性在女孩中比在男孩中更为明显。
