Lewinsohn Peter M, Shankman Stewart A, Gau Jeffrey M, Klein Daniel N
Oregon Research Institute, 1715 Franklin Blvd, Eugene, Oregon 97403-1983, USA.
Psychol Med. 2004 May;34(4):613-22. doi: 10.1017/S0033291703001466.
In previous studies of subthreshold conditions, co-morbidity has been largely ignored. The purpose was to examine rates of co-morbidity among subthreshold disorders and between subthreshold and full-syndrome disorders for the major non-psychotic classes of disorders from DSM-IV.
Participants came from the Oregon Adolescent Depression Project (mean age=16.6 years; females=52.1%). On the basis of a diagnostic interview (K-SADS), participants were assigned to eight subthreshold disorders (MDD, bipolar, eating, anxiety, alcohol use, substance use, conduct, ADHD).
Of the 1704 adolescents in the analyses, 52.5% had at least one subthreshood disorder. Of those, 40.0% had also experienced a co-morbid subthreshold condition, and 29.9% of those had a second co-morbid subthreshold condition. Of those with a subthreshold, 36.4% also had a full syndrome. The subthreshold forms of externalizing disorders were co-morbid with each other. As expected, subthreshold anxiety was co-morbid with subthreshold MDD but subthreshold anxiety was also co-morbid with subthreshold alcohol, conduct, and ADHD. The pattern of co-morbidities was nearly identical for males and females.
The hypotheses that externalizing disorders would be co-morbid with other externalizing disorders and that internalizing disorders would be co-morbid with other internalizing disorders was partially supported. Co-morbidities between subthreshold disorders and between subthreshold disorders and full syndrome should impact future research and clinical practice. The assessment of subthreshold disorders needs to include the assessment of other subthreshold and full-syndrome conditions.
在以往关于阈下状态的研究中，共病情况在很大程度上被忽视了。目的是研究《精神疾病诊断与统计手册》第四版（DSM-IV）中主要非精神病性障碍类别在阈下障碍之间以及阈下障碍与完全综合征障碍之间的共病率。
参与者来自俄勒冈青少年抑郁项目（平均年龄 = 16.6岁；女性占52.1%）。基于诊断访谈（儿童青少年情感障碍及精神分裂症问卷，K-SADS），参与者被归类为八种阈下障碍（重性抑郁障碍、双相情感障碍、饮食障碍、焦虑障碍、酒精使用障碍、物质使用障碍、品行障碍、注意缺陷多动障碍）。
在分析的1704名青少年中，52.5%至少有一种阈下障碍。其中，40.0%还经历了共病的阈下状况，而这些人中的29.9%有第二种共病的阈下状况。在有阈下障碍的人中，36.4%也有完全综合征。外化性障碍的阈下形式相互共病。正如预期的那样，阈下焦虑与阈下重性抑郁障碍共病，但阈下焦虑也与阈下酒精使用障碍、品行障碍和注意缺陷多动障碍共病。男性和女性的共病模式几乎相同。
外化性障碍会与其他外化性障碍共病以及内化性障碍会与其他内化性障碍共病的假设得到了部分支持。阈下障碍之间以及阈下障碍与完全综合征之间的共病情况应会影响未来的研究和临床实践。阈下障碍的评估需要包括对其他阈下和完全综合征状况的评估。
