Institute of Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Dresden, Germany.
Int J Methods Psychiatr Res. 2009 Dec;18(4):204-20. doi: 10.1002/mpr.293.
Previous research suggests that patterns of comorbidity of common mental disorders among adults are best reflected by a hierarchical three-factor structure with two correlated factors ('anxious-misery' and 'fear') summarized in a second-order 'internalizing' factor and one 'externalizing' factor. This three-factor structure has not been examined yet in a sample of adolescents and young adults.A representative sample of 3021 adolescents and young adults (baseline age 14-24) were prospectively followed over 10 years. Mental disorders were assessed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) by using the standardized Munich Composite International Diagnostic Interview. Ten mental disorders (major depressive episode, dysthymia, generalized anxiety disorder, social phobia, specific phobia, agoraphobia, panic disorder, alcohol dependence, drug dependence, antisocial personality) were fitted to a series of Confirmatory Factor Analysis models using: (1) 12-month data, and (2) lifetime data from a person-year data set.The three-factor model showed good fit to the observed data in our sample both when 12-month diagnoses and lifetime-to-date diagnoses from a person-year data file were used; yet the higher-order 'internalizing' factor summarizing 'anxious misery' and 'fear' had to be omitted.The three-factor model could be replicated in a sample of adolescents and young adults with the exception that the second-order 'internalizing' factor was not consistent with the data. Further research is necessary to provide more complete insight into the structure of mental disorders by examining the stability of the structure of mental disorders in different developmental stages (ages) and by using a more extensive set of mental disorders.
先前的研究表明，成年人常见精神障碍的共病模式最好由一个分层的三因素结构来反映，其中两个相关因素（“焦虑痛苦”和“恐惧”）概括在二阶“内在化”因素和一个“外在化”因素中。这个三因素结构尚未在青少年和年轻成年人样本中进行检验。
一个具有代表性的 3021 名青少年和年轻成年人样本（基线年龄 14-24 岁）被前瞻性随访了 10 年。根据《精神障碍诊断与统计手册》第四版（DSM-IV），使用标准化的慕尼黑综合国际诊断访谈，评估了精神障碍。十种精神障碍（重度抑郁发作、心境恶劣障碍、广泛性焦虑障碍、社交恐惧症、特定恐惧症、广场恐惧症、惊恐障碍、酒精依赖、药物依赖、反社会人格障碍）被适配到一系列验证性因素分析模型中，使用了：（1）12 个月的数据，和（2）来自一个人年数据集的终身数据。
三因素模型在我们的样本中，无论是使用 12 个月的诊断还是来自人年数据文件的终身诊断，都很好地符合了观察数据；然而，概括“焦虑痛苦”和“恐惧”的二阶“内在化”因素必须被省略。
三因素模型可以在青少年和年轻成年人样本中得到复制，只是二阶“内在化”因素与数据不一致。需要进一步的研究，通过检查不同发育阶段（年龄）的精神障碍结构的稳定性，以及使用更广泛的精神障碍集，来提供对精神障碍结构的更全面了解。
