Kovacs M, Gatsonis C, Paulauskas S L, Richards C
Department of Psychiatry, University of Pittsburgh School of Medicine, Pa.
Arch Gen Psychiatry. 1989 Sep;46(9):776-82. doi: 10.1001/archpsyc.1989.01810090018003.
As part of a longitudinal nosologic study of major depressive disorder (MDD), dysthymic disorder (DD), and adjustment disorder with depressed mood (ADDM) in a school-age cohort, we examined the prevalence and clinical consequences of comorbid anxiety disorders. We also estimated the risk of a first anxiety disorder and examined its predictors. Of 104 cases, 41% had anxiety disorders in conjunction with their index depression, which was more likely with MDD and DD than with ADDM. The age-corrected risk of a first anxiety disorder was 0.47 up to age 18 years. Separation-anxiety disorder was the most frequent diagnosis of anxiety, followed by overanxious disorder of childhood. Among the MDD cases with comorbidity, the anxiety disorder preceded the depression about two thirds of the time and often persisted after the depression remitted. The effect of comorbid anxiety disorder on the length of index MDD depended on the presence of other clinical features, but it did not seem to affect the risk of subsequent MDD or the course of DD or ADDM. Concurrent maternal psychopathology and poor physical health increased the risk of anxiety disorder in the children, but a history of prior separation from parental figures did not seem to have an effect.
作为一项针对学龄儿童队列中重度抑郁症（MDD）、恶劣心境障碍（DD）和伴抑郁心境的适应障碍（ADDM）的纵向疾病分类研究的一部分，我们研究了共病焦虑症的患病率及临床后果。我们还估算了首次发生焦虑症的风险并对其预测因素进行了研究。在104例病例中，41%的患者在患有原发性抑郁症的同时还患有焦虑症，其中MDD和DD患者比ADDM患者更易出现这种情况。到18岁时，经年龄校正后的首次发生焦虑症的风险为0.47。分离性焦虑障碍是最常见的焦虑症诊断类型，其次是儿童过度焦虑障碍。在合并焦虑症的MDD病例中，约三分之二的情况下焦虑症先于抑郁症出现，且常在抑郁症缓解后仍持续存在。共病焦虑症对原发性MDD病程长短的影响取决于其他临床特征的存在情况，但似乎并不影响后续发生MDD的风险或DD及ADDM的病程。母亲同时患有精神疾病和身体健康状况不佳会增加儿童患焦虑症的风险，但既往与父母分离的经历似乎并无影响。
