Department of Psychology, University of California, Los Angeles.
Depress Anxiety. 2014 Mar;31(3):207-13. doi: 10.1002/da.22250. Epub 2014 Feb 27.
Identification of youth at risk for anxiety and unipolar mood disorders (UMDs) can improve public health by targeting those who may warrant early or preventive intervention. This study examined whether endorsing core features of anxiety and UMDs predicted onset of later anxiety and UMDs across the next 7-9 years, and whether having subthreshold or subclinical manifestations of these disorders similarly predicted onset.
Data from this study come from the Youth Emotion Project (YEP), a two-site investigation of common and specific risk factors for emotional disorders. Endorsement of core features of a disorder and subclinical or subthreshold anxiety and UMD diagnoses were determined using data from the Structured Clinical Interview for DSM-IV (SCID) at the baseline assessment. Participants completed annual SCIDs over the course of the next 7-9 years (depending on cohort).
Endorsement of panic attacks, obsessions and/or compulsions, and depression and/or anhedonia predicted onset of panic disorder, obsessive compulsive disorder, and major depressive disorder, respectively. When including all anxiety disorders in a model, only the presence of panic attacks uniquely predicted anxiety disorder onset. The presence of subclinical or subthreshold panic disorder, obsessive compulsive disorder, and social phobia at baseline predicted the full onset of these disorders over the follow-up period.
Experiencing some symptoms of anxiety and UMDs in the absence of meeting diagnostic criteria is indicative of risk for later onsets of clinically significant DSM manifestations of these disorders. These individuals should be identified and targeted for prevention programs.
识别出有焦虑和单相心境障碍(UMD)风险的年轻人,可以通过针对那些可能需要早期或预防性干预的人群来改善公共卫生。本研究探讨了是否认同焦虑和 UMD 的核心特征可以预测接下来 7-9 年内是否会出现焦虑和 UMD,以及是否存在这些疾病的亚阈值或亚临床症状同样可以预测发病。
本研究的数据来自青年情绪项目(YEP),这是一项针对情绪障碍的常见和特定风险因素的双站点研究。在基线评估中使用 DSM-IV 结构临床访谈(SCID)的数据确定了对障碍核心特征的认同,以及亚临床或亚阈值焦虑和 UMD 诊断。参与者在接下来的 7-9 年(取决于队列)内每年完成 SCID。
出现惊恐发作、强迫观念和/或强迫行为以及抑郁和/或快感缺失分别预测了惊恐障碍、强迫症和重性抑郁障碍的发病。当在一个模型中包括所有焦虑障碍时,只有惊恐发作的存在才能唯一预测焦虑障碍的发病。在基线时存在亚临床或亚阈值惊恐障碍、强迫症和社交恐惧症,预示着这些障碍在随访期间会完全发病。
在未达到诊断标准的情况下出现一些焦虑和 UMD 症状表明这些障碍的临床显著 DSM 表现有发病风险。这些人应被识别出来,并作为预防计划的目标人群。