美国国家共病调查再版青少年增补版（NCS-A）中 DSM-IV 障碍的终身共病。
Lifetime co-morbidity of DSM-IV disorders in the US National Comorbidity Survey Replication Adolescent Supplement (NCS-A).
机构信息
Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA.
出版信息
Psychol Med. 2012 Sep;42(9):1997-2010. doi: 10.1017/S0033291712000025. Epub 2012 Jan 25.
BACKGROUND
Research on the structure of co-morbidity among common mental disorders has largely focused on current prevalence rather than on the development of co-morbidity. This report presents preliminary results of the latter type of analysis based on the US National Comorbidity Survey Replication Adolescent Supplement (NCS-A).
METHOD
A national survey was carried out of adolescent mental disorders. DSM-IV diagnoses were based on the Composite International Diagnostic Interview (CIDI) administered to adolescents and questionnaires self-administered to parents. Factor analysis examined co-morbidity among 15 lifetime DSM-IV disorders. Discrete-time survival analysis was used to predict first onset of each disorder from information about prior history of the other 14 disorders.
RESULTS
Factor analysis found four factors representing fear, distress, behavior and substance disorders. Associations of temporally primary disorders with the subsequent onset of other disorders, dated using retrospective age-of-onset (AOO) reports, were almost entirely positive. Within-class associations (e.g. distress disorders predicting subsequent onset of other distress disorders) were more consistently significant (63.2%) than between-class associations (33.0%). Strength of associations decreased as co-morbidity among disorders increased. The percentage of lifetime disorders explained (in a predictive rather than a causal sense) by temporally prior disorders was in the range 3.7-6.9% for earliest-onset disorders [specific phobia and attention deficit hyperactivity disorder (ADHD)] and much higher (23.1-64.3%) for later-onset disorders. Fear disorders were the strongest predictors of most other subsequent disorders.
CONCLUSIONS
Adolescent mental disorders are highly co-morbid. The strong associations of temporally primary fear disorders with many other later-onset disorders suggest that fear disorders might be promising targets for early interventions.
背景
针对常见精神障碍共病结构的研究大多集中在当前流行率上，而不是共病的发展上。本报告根据美国国家共病调查复制青少年补充调查（NCS-A），呈现了后者类型分析的初步结果。
方法
对青少年精神障碍进行了一项全国性调查。DSM-IV 诊断基于对青少年进行的复合国际诊断访谈（CIDI）和家长自行填写的问卷。因子分析检验了 15 种终生 DSM-IV 障碍之间的共病情况。离散时间生存分析用于根据先前 14 种疾病的病史预测每种疾病的首次发病。
结果
因子分析发现了四个代表恐惧、痛苦、行为和物质障碍的因子。使用回溯年龄发病（AOO）报告来确定时间上的主要疾病与随后其他疾病的发病之间的关联几乎都是阳性的。同一类别内的关联（例如，痛苦障碍预测随后其他痛苦障碍的发病）比不同类别之间的关联（33.0%）更一致地显著（63.2%）。随着障碍之间共病的增加，关联的强度下降。在预测而不是因果意义上，时间上优先的障碍解释的终生障碍比例在最早发病的障碍（特定恐惧症和注意缺陷多动障碍（ADHD））范围内为 3.7-6.9%，而在后来发病的障碍中则高得多（23.1-64.3%）。恐惧障碍是大多数其他随后障碍的最强预测因素。
结论
青少年精神障碍高度共病。时间上主要的恐惧障碍与许多其他后来发病的障碍之间的强烈关联表明，恐惧障碍可能是早期干预的有前途的目标。
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