Greenfield Brenna L, Sittner Kelley J, Forbes Miriam K, Walls Melissa L, Whitbeck Les B
University of Minnesota Medical School, Duluth campus.
Oklahoma State University, Stillwater.
J Am Acad Child Adolesc Psychiatry. 2017 Feb;56(2):133-139.e1. doi: 10.1016/j.jaac.2016.11.009. Epub 2016 Nov 27.
The aim of this study was to identify separate and joint trajectories of conduct disorder (CD) and alcohol use disorder (AUD) DSM-IV diagnostic symptoms among American Indian and First Nation (Indigenous) youth aged 10 to 18 years, and to characterize baseline profiles and later outcomes associated with joint trajectory group membership.
Data were collected between 2002 and 2010 on three indigenous reservations in the northern Midwest and four Canadian reserves (N = 673). CD and substance use disorder (SUD) were measured using the DSM-IV Diagnostic Interview Schedule for Children-Revised (DISC-R), administered at four time points.
Using group-based trajectory modeling, three CD and four AUD trajectories were found. Both had a small group with high symptoms, but the largest groups for both had no symptoms (55% and 73%, respectively). CD symptom trajectories began at age 10 years and peaked at age 14; AUD trajectories began at age 12 years and were highest from age 16 on. Eight joint trajectories were identified. Of the sample, 53% fell into the group with no CD or AUD symptoms. Compared to symptomatic groups, this group had greater caretaker warmth, positive school adjustment, less discrimination, and fewer deviant peers, and were less likely to have a caretaker with major depression at baseline. Symptomatic groups had higher odds of high school dropout, sex under the influence, and arrest at age 17 to 20 years.
Despite significant risk factors, a large proportion of Indigenous youth had no CD-SUD symptoms over time. CD-SUD symptoms have multiple development trajectories and are related to early developmental risk and later psychosocial outcomes.
本研究旨在确定10至18岁美国印第安人和第一民族（原住民）青少年中品行障碍（CD）和酒精使用障碍（AUD）DSM-IV诊断症状的单独及联合轨迹，并描述与联合轨迹组成员身份相关的基线特征和后期结果。
2002年至2010年期间，在中西部北部的三个原住民保留地和四个加拿大保留地收集了数据（N = 673）。使用DSM-IV儿童诊断访谈量表修订版（DISC-R）在四个时间点测量CD和物质使用障碍（SUD）。
使用基于群体的轨迹模型，发现了三条CD轨迹和四条AUD轨迹。两者都有一小部分症状严重的群体，但两者中最大的群体都没有症状（分别为55%和73%）。CD症状轨迹始于10岁，在14岁时达到峰值；AUD轨迹始于12岁，从16岁起最高。确定了八条联合轨迹。在样本中，53%属于没有CD或AUD症状的群体。与有症状的群体相比，该群体有更多的照顾者温暖、更好的学校适应、更少的歧视和更少的偏差同伴，并且在基线时更不可能有患有重度抑郁症的照顾者。有症状的群体在17至20岁时高中辍学、受影响下发生性行为和被捕的几率更高。
尽管存在重大风险因素，但随着时间的推移，很大一部分原住民青少年没有CD-SUD症状。CD-SUD症状有多种发展轨迹，并且与早期发育风险和后期心理社会结果相关。
