Centre for Community Child Health, and 3Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia.
Depress Anxiety. 2011 Jan;28(1):50-7. doi: 10.1002/da.20743.
This article discusses the importance of and one approach to translational research to prevent internalizing problems very early in life. The World Health Organisation (WHO) predicts that by 2,030 internalizing problems will be second only to HIV/AIDS in the international burden of disease. Internalizing problems affect one in every seven school age children, with negative impacts on peer relations, school engagement, and later mental health, adult relationships, and employment. There is persuasive evidence that intervention in the preschool years can have a cost-effective impact on general developmental outcomes, compared to later school or adult intervention. However, the development of early childhood prevention for internalizing problems is in its infancy. Two significant risk factors for child internalizing problems are temperamental inhibition (characterized by fearfulness and withdrawal) and overinvolved/protective parenting practices. Rapee et al. have conducted two randomized "efficacy" trials with inhibited preschoolers in which a parenting group intervention reduced internalizing disorders up to 3 years later. Translational "effectiveness" research is now underway at the population level, to determine the balance of benefits and harms of systematically screening preschoolers for inhibition and subsequent intervention for all those affected. This rigorous public health research, followed by effective dissemination, addresses gaps identified in the WHO Prevention of Mental Disorders report.
本文讨论了开展转化研究的重要性及其方法，以在生命早期预防内化问题。世界卫生组织（WHO）预测，到 2030 年，内化问题在国际疾病负担中仅次于艾滋病毒/艾滋病。内化问题影响每七个学龄儿童中的一个，对同伴关系、学校参与度以及以后的心理健康、成年关系和就业产生负面影响。有充分证据表明，与以后的学校或成年干预相比，在学前阶段进行干预可以对一般发展结果产生具有成本效益的影响。然而，内化问题的幼儿期预防措施仍处于起步阶段。儿童内化问题的两个重要风险因素是气质抑制（表现为恐惧和退缩）和过度参与/保护性养育方式。Rapee 等人对有抑制表现的学龄前儿童进行了两项随机“疗效”试验，结果表明，父母养育小组干预可将内化障碍减少 3 年。目前正在进行针对人群的转化“有效性”研究，以确定对所有受影响者进行系统筛查和随后进行干预的益处和危害之间的平衡。这项严格的公共卫生研究，以及有效的传播，解决了世界卫生组织预防精神障碍报告中确定的差距。
