Luby Joan L, Si Xuemei, Belden Andy C, Tandon Mini, Spitznagel Ed
Department of Psychiatry, Washington University School of Medicine, St Louis, MO 63110, USA.
Arch Gen Psychiatry. 2009 Aug;66(8):897-905. doi: 10.1001/archgenpsychiatry.2009.97.
Childhood depression is a serious and relapsing psychiatric disorder. However, to date studies have focused mostly on children aged 6 years and older. Validation for depression in preschool children has been provided by 2 independent study samples. While several studies have demonstrated stability and poor outcomes of internalizing symptoms in preschoolers, there has not yet been longitudinal data available to inform the course of preschool depression and whether it shows homotypic continuity into early childhood.
To examine the 24-month course of preschool depression and whether it showed homotypic vs heterotypic continuity or was a developmentally transient phenomenon.
Blindly rated, prospective, 24-month, longitudinal follow-up study.
Community sites. Patients Three hundred six preschoolers aged 3 to 6 years recruited from community sites and oversampled for symptoms of depression. Main Outcome Measure Recurrence/stability of depression and predictors of course.
Preschoolers with depression at baseline had the highest likelihood of subsequent depression 12 and/or 24 months later compared with preschoolers with no baseline disorder and with those who had other psychiatric disorders. Preschoolers with depression at baseline were more likely to have later depression rather than other psychiatric disorders. Findings from a logistic regression analysis indicated that when controlling for demographic variables, risk factors, and comorbid disorders, depression during the preschool period and family history of affective disorders were the most robust and significant predictors of later depression.
Preschool depression, similar to childhood depression, is not a developmentally transient syndrome but rather shows chronicity and/or recurrence. Homotypic continuity of preschool MDD during a 24-month period was found. These results underscore the clinical and public health importance of identification of depression as early as preschool. Further follow-up of preschoolers with depression is warranted to inform the longitudinal course throughout childhood.
儿童期抑郁症是一种严重且易复发的精神障碍。然而，迄今为止的研究大多集中在6岁及以上的儿童。两项独立的研究样本为学龄前儿童抑郁症的验证提供了依据。虽然多项研究表明学龄前儿童内化症状具有稳定性且预后较差，但尚无纵向数据可用于了解学龄前抑郁症的病程，以及它是否会延续到幼儿期并表现出同型连续性。
研究学龄前抑郁症的24个月病程，以及它是否表现出同型或异型连续性，或者是否是一种发育过程中的短暂现象。
盲法评分、前瞻性、为期24个月的纵向随访研究。
社区场所。患者从社区场所招募了306名3至6岁的学龄前儿童，并对抑郁症症状进行了过度抽样。主要结局指标抑郁症的复发/稳定性及病程预测因素。
与无基线疾病的学龄前儿童以及患有其他精神障碍的儿童相比，基线时患有抑郁症的学龄前儿童在12个月和/或24个月后出现后续抑郁症的可能性最高。基线时患有抑郁症的学龄前儿童更有可能出现后期抑郁症而非其他精神障碍。逻辑回归分析结果表明，在控制人口统计学变量、危险因素和共病障碍后，学龄前阶段的抑郁症和情感障碍家族史是后期抑郁症最有力且显著的预测因素。
学龄前抑郁症与儿童期抑郁症一样，不是一种发育过程中的短暂综合征，而是表现出慢性和/或复发性。在24个月期间发现了学龄前重度抑郁症的同型连续性。这些结果强调了早在学龄前识别抑郁症的临床和公共卫生重要性。有必要对患有抑郁症的学龄前儿童进行进一步随访，以了解整个儿童期的纵向病程。
