Copeland William, Shanahan Lilly, Costello E Jane, Angold Adrian
Developmental Epidemiology Program, Duke University Medical Center, Durham, NC 27710, USA.
J Child Psychol Psychiatry. 2009 Apr;50(4):451-9. doi: 10.1111/j.1469-7610.2008.02005.x. Epub 2009 Feb 10.
Co-occurrence of psychosocial risk factors is commonplace, but little is known about psychiatrically-predictive configurations of psychosocial risk factors.
Latent class analysis (LCA) was applied to 17 putative psychosocial risk factors in a representative population sample of 920 children ages 9 to 17. The resultant class structure was retested in a representative population sample of 1420 children aged 9 to 13. In each sample, the child and one parent were interviewed with the Child and Adolescent Psychiatric Assessment. Concurrent psychiatric status was used to validate class membership.
LCA identified five latent classes in both samples: two low risk classes; two moderate risk classes both involving family poverty configured with various other risk factors; and a high risk class characterized by family relational dysfunction and parental risk characteristics. Of the primary sample, 48.6% were categorized as low risk, 42.8% as moderate risk, and 8.6% as high risk. Moderate risk classes differed in their prediction of disruptive and emotional disorders depending on their specific risk factor configurations. High risk youth had the highest levels of both emotional and disruptive disorders. Combining our latent classes with a cumulative risk approach best accounted for the effects of risk factors on psychopathology in our primary sample.
Particular risk configurations have specific associations with psychiatric disorders. Configurational approaches are an important asset for large-scale epidemiological studies that integrate information about patterns of risk and disorders.
心理社会风险因素同时出现的情况很常见，但对于心理社会风险因素的精神病学预测组合却知之甚少。
对920名9至17岁儿童的代表性人群样本中的17个假定心理社会风险因素进行了潜在类别分析（LCA）。在1420名9至13岁儿童的代表性人群样本中对所得的类别结构进行了重新测试。在每个样本中，对儿童和一名家长进行了儿童与青少年精神病学评估访谈。同时期的精神状态用于验证类别归属。
LCA在两个样本中均确定了五个潜在类别：两个低风险类别；两个中度风险类别，均涉及家庭贫困并与各种其他风险因素组合；以及一个以家庭关系功能障碍和父母风险特征为特征的高风险类别。在主要样本中，48.6%被归类为低风险，42.8%为中度风险，8.6%为高风险。中度风险类别根据其特定的风险因素组合对破坏性行为和情绪障碍的预测有所不同。高风险青少年的情绪和破坏性行为障碍水平最高。将我们的潜在类别与累积风险方法相结合，最能解释主要样本中风险因素对精神病理学的影响。
特定的风险组合与精神障碍有特定关联。组合方法是大规模流行病学研究的一项重要资产，这些研究整合了有关风险模式和障碍的信息。
