Centre de Recherche en Epidémiologie et Santé des Populations (CESP), Institut National de la Santé et de la Recherche Médicale (INSERM) U1018, Paris-Saclay University, Paris, France.
Assistance Publique-Hôpitaux de Paris (AP-HP), Bicêtre Hôpitaux Universitaires Paris Sud, Public Health and Epidemiology Department, Le Kremlin-Bicêtre, France.
JAMA Psychiatry. 2018 Nov 1;75(11):1173-1181. doi: 10.1001/jamapsychiatry.2018.2119.
The onset of adult psychopathologic disorders can be traced to behavioral or emotional symptoms observed in childhood, which could be targeted in early interventions to prevent future mental disorders. The network perspective is a novel conceptualization of psychopathologic disorders that could help to identify target symptoms with a distinct role in the emergence of mental illness.
To assess whether the network structure of emotional and behavioral symptoms among elementary school girls is associated with anxiety disorders or major depression in early adulthood.
DESIGN, SETTING, AND PARTICIPANTS: The Quebec Longitudinal Study of Kindergarten Children is an ongoing, prospective, population-based study of kindergarten children attending French-speaking state schools in the Canadian province of Quebec in 1986-1988. This study included 932 girls whose parents completed the Social Behavior Questionnaire when the girls were ages 6 (baseline), 8, and 10 years; 780 participants were interviewed to assess the presence of mental disorders at age 15 and/or 22 years. Data analysis was conducted from December 2016 to April 2018.
Gaussian graphical models were estimated for 33 symptoms (eg, internalizing, externalizing, and prosocial behaviors) assessed using the Social Behavior Questionnaire to evaluate the temporal stability of the symptom network through childhood. At follow-up time points, mental disorders were assessed using the DSM-III-R, and symptom networks were reestimated at ages 6 to 10 years, this time including a variable indicative of future diagnosis.
At baseline, the mean (SD) age of the 932 girls was 6.0 (0.3) years. Among the 780 women assessed at follow-up, 270 (34.6%) and 128 (16.4%) had developed anxiety disorders and major depression, respectively. Symptoms clustered in internalizing and externalizing communities. Five symptoms-irritable, blames others, not liked by others, often cries, and solitary-emerged as bridge symptoms between the disruptive and internalizing communities. These symptoms were those that were connected with the highest regularized edge weights (from 0.015 to 0.076) to future anxiety disorders once added to the network. Bootstrapped 95% CIs ranged from (95% CI, -0.063 to 0.068) to (95% CI, 0.561 to 0.701) for positive edges and from (95% CI, -0.156 to 0.027) to (95% CI, -0.081 to 0.078) for negative edges included in the regularized network.
Bridge symptoms between disruptive and internalizing communities are identified for the first time in childhood, and these findings suggest that these symptoms could be central in indicating probable later anxiety disorders. The study suggests that bridge symptoms should be investigated further as potential early targets in disease-prevention interventions.
成年精神病理障碍的发作可以追溯到儿童期观察到的行为或情绪症状，这些症状可以作为早期干预的目标，以预防未来的精神障碍。网络视角是一种新的精神病理障碍概念化方法，可以帮助确定在精神疾病出现中具有独特作用的目标症状。
评估小学女生情绪和行为症状的网络结构是否与成年早期的焦虑障碍或重度抑郁症有关。
设计、地点和参与者：魁北克幼儿园纵向研究是一项正在进行的、前瞻性的、基于人群的研究，对 1986-1988 年在加拿大魁北克省讲法语的公立学校就读的幼儿园儿童进行了研究。这项研究包括 932 名女孩，她们的父母在女孩 6 岁（基线）、8 岁和 10 岁时完成了社会行为问卷；780 名参与者接受了访谈，以评估他们在 15 岁和/或 22 岁时是否存在精神障碍。数据分析于 2016 年 12 月至 2018 年 4 月进行。
使用社会行为问卷评估了 33 个症状（例如，内化、外化和亲社会行为），使用高斯图形模型评估了这些症状在整个儿童期的时间稳定性。在随访时间点，使用 DSM-III-R 评估了精神障碍，并在 6 岁至 10 岁时重新估计了症状网络，此时包括了一个指示未来诊断的变量。
在基线时，932 名女孩的平均（SD）年龄为 6.0（0.3）岁。在接受随访的 780 名女性中，分别有 270 名（34.6%）和 128 名（16.4%）发展为焦虑障碍和重度抑郁症。症状聚类为内化和外化社区。五种症状——易怒、责怪他人、不受他人喜欢、经常哭泣和孤独——作为破坏性行为和内化社区之间的桥梁症状出现。这些症状是那些与未来焦虑障碍关联度最高的正则化边缘权重（从 0.015 到 0.076）的症状，这些症状被添加到网络中后。经过自举 95%置信区间的范围为（95%CI，-0.063 到 0.068）至（95%CI，0.561 到 0.701）的阳性边缘和（95%CI，-0.156 到 0.027）至（95%CI，-0.081 到 0.078）的阴性边缘，包括正则化网络。
首次在儿童时期确定了破坏性行为和内化社区之间的桥梁症状，这些发现表明，这些症状可能是预示着可能的后期焦虑障碍的核心。该研究表明，桥梁症状应作为疾病预防干预的潜在早期目标进一步研究。
