Section of Clinical Neuropsychology, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands and Accare, Center for Child and Adolescent Psychiatry, University Medical Center Groningen, Groningen.
Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam.
J Am Acad Child Adolesc Psychiatry. 2017 Jul;56(7):556-569. doi: 10.1016/j.jaac.2017.05.004. Epub 2017 May 11.
To assess the prospective risk of developing substance-related disorders after childhood mental health disorders (i.e., attention-deficit/hyperactivity disorder [ADHD], oppositional defiant disorder [ODD] or conduct disorder [CD], anxiety disorder, and depression) using meta-analysis.
PubMed, Embase, and PsycInfo were searched for relevant longitudinal studies that described childhood (<18 years old) ADHD, ODD or CD, anxiety, or depression in relation to later alcohol-, nicotine-, or drug-related disorders or substance use disorders (SUDs) published in peer-reviewed journals in the English language from 1986 to May 2016. Two researchers conducted all review stages. Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines were followed.
Thirty-seven studies including more than 762,187 participants were identified for quantitative analyses. These studies included 22,029 participants with ADHD, 434 participants with ODD or CD, 1,433 participants with anxiety disorder, and 2,451 participants with depression. Ninety-seven effects sizes were extracted for analyses. Meta-analysis showed a significantly increased risk for addiction in ADHD (n = 23, odds ratio [OR] 2.27, 95% CI 1.98-3.67; OR alcohol 2.15, 95% CI 1.56-2.97; OR drugs 1.52, 95% CI 1.52-5.27; OR nicotine 2.52, 95% CI 2.01-3.15; OR SUDs 2.61, 95% CI 1.77-3.84), ODD or CD (n = 8, OR 3.18, 95% CI 1.97-5.80; OR alcohol 1.73, 95% CI 1.51-2.00; OR drugs 4.24, 95% CI 1.3.21.5.59; OR nicotine 4.22, 95% CI 3.21-5.55; OR SUDs 4.86, 95% CI 3.09-7.56), and depression (n = 13, OR 2.03, 95% CI 1.47-2.81; OR alcohol 1.10, 95% CI 1.02-1.19; OR nicotine 2.56, 95% CI 1.89-3.48; OR SUDs 2.20, 95% CI 1.41-3.43), but not for anxiety disorders (n = 15, OR 1.34, 95% CI 0.90-1.55, not significant).
Childhood ADHD, ODD, CD, and depression increase the risk of developing substance-related disorders. Anxiety disorders do not seem to increase the risk for future substance-related disorders, although the findings are highly heterogeneous. These findings emphasize the need for early detection and intervention to prevent debilitating substance-related disorders in later life.
采用荟萃分析评估儿童期精神障碍（即注意缺陷多动障碍[ADHD]、对立违抗性障碍[ODD]或品行障碍[CD]、焦虑症和抑郁症）后物质相关障碍的前瞻性发病风险。
检索了从 1986 年到 2016 年 5 月在同行评审期刊上发表的关于儿童（<18 岁）ADHD、ODD 或 CD、焦虑症或抑郁症与后来的酒精、尼古丁或药物相关障碍或物质使用障碍（SUD）之间关系的相关纵向研究的相关文献，使用的数据库为 PubMed、Embase 和 PsycInfo。两位研究人员进行了所有的审查阶段。遵循观察性研究的荟萃分析（MOOSE）指南。
确定了 37 项研究，其中包括超过 762187 名参与者进行定量分析。这些研究包括 22029 名 ADHD 参与者、434 名 ODD 或 CD 参与者、1433 名焦虑症参与者和 2451 名抑郁症参与者。共提取了 97 个效应大小进行分析。荟萃分析显示 ADHD（n=23）、ODD 或 CD（n=8）和抑郁症（n=13）患者的成瘾风险显著增加，ADHD 的优势比（OR）为 2.27（95%CI 1.98-3.67；OR 酒精 2.15，95%CI 1.56-2.97；OR 药物 1.52，95%CI 1.52-5.27；OR 尼古丁 2.52，95%CI 2.01-3.15；OR SUDs 2.61，95%CI 1.77-3.84）、ODD 或 CD（OR 3.18，95%CI 1.97-5.80；OR 酒精 1.73，95%CI 1.51-2.00；OR 药物 4.24，95%CI 1.3.21.5.59；OR 尼古丁 4.22，95%CI 3.21-5.55；OR SUDs 4.86，95%CI 3.09-7.56）和抑郁症（n=13，OR 2.03，95%CI 1.47-2.81；OR 酒精 1.10，95%CI 1.02-1.19；OR 尼古丁 2.56，95%CI 1.89-3.48；OR SUDs 2.20，95%CI 1.41-3.43）患者发生物质相关障碍的风险增加，但焦虑症（n=15，OR 1.34，95%CI 0.90-1.55，无统计学意义）患者则不然。
儿童期 ADHD、ODD、CD 和抑郁症增加了发生物质相关障碍的风险。焦虑症似乎不会增加未来物质相关障碍的风险，尽管结果高度异质。这些发现强调需要早期发现和干预，以预防成年后致残性物质相关障碍。
