Luby Joan L, Gaffrey Michael S, Tillman Rebecca, April Laura M, Belden Andy C
Am J Psychiatry. 2014 Jul;171(7):768-76. doi: 10.1176/appi.ajp.2014.13091198.
Preschool-onset depression, a developmentally adapted form of depression arising between ages 3 and 6, has demonstrated numerous validated features, including characteristic alterations in stress reactivity and brain function. This syndrome is characterized by subthreshold DSM criteria for major depressive disorder, raising questions about its clinical significance. To clarify the utility and public health significance of the preschool-onset depression construct, the authors investigated diagnostic outcomes of preschool children at school age and in adolescence.
In a longitudinal prospective study of preschool children, the authors assessed the likelihood of meeting full criteria for major depressive disorder at age 6 or later as a function of preschool depression, other preschool axis I disorders, maternal history of depression, nonsupportive parenting, and traumatic life events.
Preschool-onset depression emerged as a robust predictor of major depressive disorder in later childhood even after accounting for the effect of maternal history of depression and other risk factors. Preschool-onset conduct disorder also predicted major depression in later childhood, but this association was partially mediated by nonsupportive parenting, reducing by 21% the effect of preschool conduct disorder in predicting major depression.
Study findings provide evidence that this preschool depressive syndrome is a robust risk factor for developing full criteria for major depression in later childhood, over and above other established risk factors. The results suggest that attention to preschool depression and conduct disorder in addition to maternal history of depression and exposure to trauma may be important in identifying young children at highest risk for later major depression and applying early interventions.
学龄前起病的抑郁症是一种在3至6岁之间出现的适应发育的抑郁症形式，已表现出许多经过验证的特征，包括应激反应性和脑功能的特征性改变。该综合征的特征是符合重度抑郁症的阈下诊断标准，这引发了对其临床意义的质疑。为了阐明学龄前起病的抑郁症这一概念的实用性和公共卫生意义，作者调查了学龄前儿童在学龄期和青春期的诊断结果。
在一项对学龄前儿童的纵向前瞻性研究中，作者评估了6岁及以后符合重度抑郁症全部标准的可能性，将其作为学龄前抑郁症、其他学龄前轴I障碍、母亲抑郁症病史、非支持性养育方式和创伤性生活事件的函数。
即使在考虑了母亲抑郁症病史和其他风险因素的影响后，学龄前起病的抑郁症仍是儿童后期重度抑郁症的有力预测指标。学龄前起病的品行障碍也可预测儿童后期的重度抑郁症，但这种关联部分由非支持性养育方式介导，使学龄前品行障碍在预测重度抑郁症中的作用降低了21%。
研究结果提供了证据，表明这种学龄前抑郁综合征是儿童后期发展为符合重度抑郁症全部标准的有力风险因素，超过了其他已确定的风险因素。结果表明，除了关注母亲抑郁症病史和创伤暴露外，关注学龄前抑郁症和品行障碍对于识别后期患重度抑郁症风险最高的幼儿并实施早期干预可能很重要。
