Vanderbilt University, Nashville, TN 37203-5721, USA.
J Child Psychol Psychiatry. 2010 Mar;51(3):242-9. doi: 10.1111/j.1469-7610.2009.02155.x. Epub 2009 Oct 28.
This study examined the temporal comorbidity of depressive disorders with anxiety, externalizing, and substance use disorders in adolescents who varied in risk for depression.
Participants were 240 adolescents and their mothers who had either a history of depression (high-risk, n = 185) or were lifetime-free of psychiatric disorders (low-risk, n = 55). Children (54.2% females) were first evaluated in 6th grade (mean age = 11.86, SD = .57) with the K-SADS-PL to assess current and lifetime diagnoses, and then annually through 12th grade with the A-LIFE to assess diagnoses since the previous evaluation.
For girls, the rate of depression was high regardless of prior anxiety, whereas for boys, the odds that those with prior subthreshold anxiety would have subsequent subthreshold depression were 1.5 times those of boys with no prior subthreshold anxiety, controlling for risk. In addition, the odds that girls with prior substance use disorders would have a threshold depressive disorder subsequently were three times those of girls with no prior substance use disorders, controlling for risk.
These results highlight the importance of early detection of various forms of psychopathology in youth who then can be targeted for intervention. The prospective paths to comorbidity differed by sex, thus suggesting that interventions need to be constructed with sensitivity to these distinct diagnostic trajectories.
本研究考察了抑郁障碍与焦虑、外化和物质使用障碍在具有不同抑郁风险的青少年中的时间共病情况。
参与者为 240 名青少年及其母亲，其中有抑郁病史（高风险，n=185）或终生无精神障碍（低风险，n=55）。儿童（54.2%为女性）首先在 6 年级（平均年龄=11.86，SD=.57）接受 K-SADS-PL 评估，以评估当前和终生诊断，然后通过 A-LIFE 每年评估一次，以评估上次评估以来的诊断。
对于女孩，无论先前是否有焦虑，抑郁的发生率都很高，而对于男孩，与没有先前亚阈值焦虑的男孩相比，先前有亚阈值焦虑的男孩随后出现亚阈值抑郁的几率是其 1.5 倍，控制风险。此外，与没有先前物质使用障碍的女孩相比，有先前物质使用障碍的女孩随后出现阈值抑郁障碍的几率是其 3 倍，控制风险。
这些结果强调了早期发现青少年各种形式精神病理学的重要性，然后可以针对这些青少年进行干预。共病的前瞻性路径因性别而异，因此表明干预措施需要针对这些不同的诊断轨迹进行构建。
