在美国国家共病调查复制青少年补充调查（NCS-A）中，继发性共病精神障碍对DSM-IV注意力缺陷多动障碍（ADHD）与不良后果之间关联的影响。
The effects of temporally secondary co-morbid mental disorders on the associations of DSM-IV ADHD with adverse outcomes in the US National Comorbidity Survey Replication Adolescent Supplement (NCS-A).
作者信息
Kessler R C, Adler L A, Berglund P, Green J G, McLaughlin K A, Fayyad J, Russo L J, Sampson N A, Shahly V, Zaslavsky A M
机构信息
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
Departments of Psychiatry and Child and Adolescent Psychiatry, NYU School of Medicine and Psychiatry, NY VA Harbor Healthcare Service, New York, NY, USA.
出版信息
Psychol Med. 2014 Jun;44(8):1779-92. doi: 10.1017/S0033291713002419. Epub 2013 Oct 8.
BACKGROUND
Although DSM-IV attention deficit hyperactivity disorder (ADHD) is known to be associated with numerous adverse outcomes, uncertainties exist about how much these associations are mediated temporally by secondary co-morbid disorders.
METHOD
The US National Comorbidity Survey Replication Adolescent Supplement (NCS-A), a national survey of adolescents aged 13-17 years (n = 6483 adolescent-parent pairs), assessed DSM-IV disorders with the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Statistical decomposition was used to compare direct effects of ADHD with indirect effects of ADHD through temporally secondary mental disorders (anxiety, mood, disruptive behavior, substance disorders) in predicting poor educational performance (suspension, repeating a grade, below-average grades), suicidality (ideation, plans, attempts) and parent perceptions of adolescent functioning (physical and mental health, interference with role functioning and distress due to emotional problems).
RESULTS
ADHD had significant gross associations with all outcomes. Direct effects of ADHD explained most (51.9-67.6%) of these associations with repeating a grade in school, perceived physical and mental health (only girls), interference with role functioning and distress, and significant components (34.5-44.6%) of the associations with school suspension and perceived mental health (only boys). Indirect effects of ADHD on educational outcomes were predominantly through disruptive behavior disorders (26.9-52.5%) whereas indirect effects on suicidality were predominantly through mood disorders (42.8-59.1%). Indirect effects on most other outcomes were through both mood (19.8-31.2%) and disruptive behavior (20.1-24.5%) disorders, with anxiety and substance disorders less consistently important. Most associations were comparable for girls and boys.
CONCLUSIONS
Interventions aimed at reducing the adverse effects of ADHD might profitably target prevention or treatment of temporally secondary co-morbid disorders.
背景
尽管已知《精神疾病诊断与统计手册》第四版（DSM-IV）中的注意力缺陷多动障碍（ADHD）与众多不良后果相关，但这些关联在多大程度上由继发性共病障碍在时间上介导仍存在不确定性。
方法
美国国家共病调查复制青少年补充调查（NCS-A）是一项针对13至17岁青少年（n = 6483对青少年-家长）的全国性调查，使用世界卫生组织（WHO）复合国际诊断访谈（CIDI）评估DSM-IV障碍。采用统计分解方法，比较ADHD的直接效应与ADHD通过时间上继发性精神障碍（焦虑、情绪、破坏性行为、物质使用障碍）对预测不良教育表现（停学、留级、成绩低于平均水平）、自杀倾向（想法、计划、尝试）以及家长对青少年功能的认知（身心健康、角色功能干扰和情绪问题导致的困扰）的间接效应。
结果
ADHD与所有结局均存在显著的总体关联。ADHD的直接效应解释了这些关联中的大部分（51.9 - 67.6%），包括在学校留级、感知到的身心健康（仅女孩）、角色功能干扰和困扰，以及与停学和感知到的心理健康（仅男孩）关联中的重要组成部分（34.5 - 44.6%）。ADHD对教育结局的间接效应主要通过破坏性行为障碍（26.9 - 52.5%），而对自杀倾向的间接效应主要通过情绪障碍（42.8 - 59.1%）。对大多数其他结局的间接效应通过情绪（19.8 - 31.2%）和破坏性行为（20.1 - 24.5%）障碍，焦虑和物质使用障碍的重要性不太一致。大多数关联在女孩和男孩中相当。
结论
旨在减少ADHD不良影响的干预措施可能有益地针对预防或治疗时间上继发性共病障碍。
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