Department of Psychiatry, Western Psychiatric Institute & Clinic, University of Pittsburgh, Pittsburgh, PA 15213, USA.
J Child Psychol Psychiatry. 2011 Oct;52(10):1099-108. doi: 10.1111/j.1469-7610.2011.02448.x. Epub 2011 Aug 4.
Little is known about the role of oppositional defiant disorder (ODD) dimensions on the temporal unfolding of conduct disorder (CD) and depression in girls between childhood and adolescence.
The year-to-year associations between CD and depressive symptomatology were examined using nine waves of annually collected data (ages 8 through 16 years) from 1215 participants of the Pittsburgh Girls Study. A series of autoregressive path models were tested that included ODD-Emotion Dysregulation (ODD-ED) and ODD-Defiance, as time-varying covariates on CD predicting depression severity in the following year, and vice versa.
Conduct problems, depression, and ODD dimensions were relatively stable throughout childhood and adolescence, and a moderate degree of covariance was observed between these variables. Path analyses showed that CD often preceded depression across this developmental period, although the effect sizes were small. There was less consistent prediction from depression to CD. The overlap between ODD-ED and CD partially explained the prospective relations from CD to depression, whereas these paths were fully explained by the overlap between ODD-ED and depression. The overlap between ODD-Defiance and CD did not account for the prospective relations from CD to depression. In contrast, the overlap between ODD-Defiance and depression accounted for virtually all paths from CD to depression. Accounting for the overlap between ODD dimensions and both CD and depression eliminated all significant predictive paths.
Symptoms of CD tend to precede depression in girls during childhood and adolescence. However, covariance between depression and both ODD-ED and ODD-Defiance accounts for these prospective relations. ODD dimensions should be assessed when evaluating risk for comorbid depression in girls with conduct problems, and emotion dysregulation and defiance aspects of ODD should be identified as targets for treatment in order to prevent depression in the future.
对于对立违抗性障碍（ODD）维度在女童从儿童期到青春期期间对品行障碍（CD）和抑郁的时间发展中的作用，我们知之甚少。
使用来自匹兹堡女孩研究的 1215 名参与者的 9 年每年收集一次的数据（年龄 8 至 16 岁），通过一系列自回归路径模型来检验 CD 和抑郁症状之间的逐年关联。这些模型将 ODD-情绪失调（ODD-ED）和 ODD-反抗作为时变协变量，纳入 CD 预测次年抑郁严重程度的模型中，反之亦然。
品行问题、抑郁和 ODD 维度在整个儿童期和青春期相对稳定，并且这些变量之间存在中度的协方差。路径分析表明，在整个发展阶段，CD 通常先于抑郁，但效应量很小。从抑郁到 CD 的预测作用则不太一致。ODD-ED 和 CD 的重叠部分解释了 CD 与抑郁之间的前瞻性关系，而 ODD-ED 和抑郁之间的重叠则完全解释了从 CD 到抑郁的前瞻性关系。ODD-反抗和 CD 之间的重叠并不能解释 CD 到抑郁的前瞻性关系。相比之下，ODD-反抗和抑郁之间的重叠则解释了从 CD 到抑郁的所有路径。考虑到 ODD 维度与 CD 和抑郁之间的重叠，消除了所有具有显著预测作用的路径。
在儿童和青少年时期，CD 的症状往往先于抑郁出现。然而，抑郁与 ODD-ED 和 ODD-反抗之间的协方差解释了这些前瞻性关系。在评估有品行问题的女孩并发抑郁的风险时，应评估 ODD 维度，并且应确定 ODD 的情绪失调和反抗方面作为未来治疗的目标，以预防抑郁。
