Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA.
J Child Psychol Psychiatry. 2012 Oct;53(10):1036-43. doi: 10.1111/j.1469-7610.2012.02567.x. Epub 2012 May 31.
To evaluate associations between attention-deficit/hyperactivity disorder (ADHD) and comorbid psychiatric disorders using research-identified incident cases of ADHD and population-based controls.
Subjects included a birth cohort of all children born 1976-1982 remaining in Rochester, MN after age five (n = 5,718). Among them we identified 379 ADHD incident cases and 758 age-gender matched non-ADHD controls, passively followed to age 19 years. All psychiatric diagnoses were identified and abstracted, but only those confirmed by qualified medical professionals were included in the analysis. For each psychiatric disorder, cumulative incidence rates for subjects with and without ADHD were estimated using the Kaplan-Meier method. Corresponding hazard ratios (HR) were estimated using Cox models adjusted for gender and mother's age and education at the subject's birth. The association between ADHD and the likelihood of having an internalizing or externalizing disorder was summarized by estimating odds ratios (OR).
Attention-deficit/hyperactivity disorder was associated with a significantly increased risk of adjustment disorders (HR = 3.88), conduct/oppositional defiant disorder (HR = 9.54), mood disorders (HR = 3.67), anxiety disorders (HR = 2.94), tic disorders (HR = 6.53), eating disorders (HR = 5.68), personality disorders (HR = 5.80), and substance-related disorders (HR = 4.03). When psychiatric comorbidities were classified on the internalization-externalization dimension, ADHD was strongly associated with coexisting internalizing/externalizing (OR = 10.6), or externalizing-only (OR = 10.0) disorders.
This population-based study confirms that children with ADHD are at significantly increased risk for a wide range of psychiatric disorders. Besides treating the ADHD, clinicians should identify and provide appropriate treatment for psychiatric comorbidities.
本研究旨在通过研究确定的 ADHD 新发病例和基于人群的对照组，评估 ADHD 与共患精神障碍之间的关联。
研究对象为明尼苏达州罗彻斯特市出生于 1976 年至 1982 年的所有五岁以上儿童（n=5718）。在此队列中，我们共确定了 379 例 ADHD 新发病例和 758 例年龄性别匹配的非 ADHD 对照组，并被动随访至 19 岁。所有精神科诊断均经确认并提取，但只有经合格的医疗专业人员确认的诊断才纳入分析。对于每种精神障碍，使用 Kaplan-Meier 法估计 ADHD 组和非 ADHD 组的累积发病率。使用 Cox 模型，根据性别和母亲在孩子出生时的年龄及受教育程度，对风险比（HR）进行调整。使用比值比（OR）估计 ADHD 与发生内化或外化障碍的可能性之间的关联。
ADHD 与适应障碍（HR=3.88）、品行/对立违抗性障碍（HR=9.54）、心境障碍（HR=3.67）、焦虑障碍（HR=2.94）、抽动障碍（HR=6.53）、进食障碍（HR=5.68）、人格障碍（HR=5.80）和物质相关障碍（HR=4.03）的风险显著增加相关。当根据内化-外化维度对精神共病进行分类时，ADHD 与同时存在内化/外化障碍（OR=10.6）或仅存在外化障碍（OR=10.0）的风险显著相关。
本基于人群的研究证实，患有 ADHD 的儿童发生各种精神障碍的风险显著增加。除了治疗 ADHD 外，临床医生还应识别和提供适当的精神共病治疗。
