注意缺陷多动障碍（ADHD）在成年期重度饮酒与抑郁轨迹共病中的作用。
Role of ADHD in the Co-Occurrence Between Heavy Alcohol Use and Depression Trajectories in Adulthood.
机构信息
Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Department of Psychology, Florida International University, Miami, Florida.
出版信息
Alcohol Clin Exp Res. 2019 Feb;43(2):342-352. doi: 10.1111/acer.13934. Epub 2018 Dec 27.
BACKGROUND
Attention-deficit/hyperactivity disorder (ADHD) is associated with greater heavy alcohol use and depressive symptoms in adulthood. Yet, few studies have investigated whether childhood ADHD predicts an increased association between heavy drinking and depression in adulthood when this co-occurrence becomes more common. We examined associations among heavy alcohol use and depression longitudinally from ages 21 to 29 and whether these associations differed for those with or without childhood ADHD, as well as for those with or without persistent ADHD in adulthood.
METHODS
Data were from the Pittsburgh ADHD Longitudinal Study, a prospective cohort of children diagnosed with ADHD and demographically similar individuals without ADHD histories. ADHD symptoms in adulthood were self- and parent reported; depressive symptoms and frequency of drinking 5 or more drinks in a single drinking occasion were self-reported and measured at 5 time-points from ages 21 to 29. Depression and alcohol use were modeled in a multiple-group, parallel process longitudinal growth model.
RESULTS
The slopes of heavy alcohol use and depression were significantly and positively associated from ages 25 to 29 but not at the younger ages. Although the strength of these associations did not differ by group (with or without ADHD, childhood or adulthood), the slopes of depression and heavy drinking at the older ages were highly variable and individuals with ADHD showed significantly faster growth in depression from ages 25 to 29.
CONCLUSIONS
Due to the strengthening association between heavy drinking and depression for adults in their late 20s, and increasing depression for adults with ADHD histories, individuals with ADHD may be at greater risk for co-occurring depression and binge drinking. Negative reinforcement-related alcohol use may strengthen as these individuals age toward the fourth decade of life. More rigorous testing of this possibility is warranted.
背景
注意力缺陷多动障碍（ADHD）与成年后大量饮酒和抑郁症状有关。然而，很少有研究调查儿童 ADHD 是否会增加成年后大量饮酒和抑郁之间的关联，因为这种共病变得更加普遍。我们从 21 岁到 29 岁的时间内纵向研究了大量饮酒和抑郁之间的关联，以及这些关联是否因儿童时期有无 ADHD，以及成年后有无持续性 ADHD 而有所不同。
方法
数据来自匹兹堡 ADHD 纵向研究，这是一项前瞻性队列研究，包括被诊断为 ADHD 的儿童和在人口统计学上没有 ADHD 病史的相似个体。成年 ADHD 症状由自我报告和父母报告；抑郁症状和单次饮酒 5 次或以上的饮酒频率由自我报告，并在 21 岁至 29 岁期间的 5 个时间点进行测量。抑郁和饮酒使用在多组平行过程纵向增长模型中进行建模。
结果
从 25 岁到 29 岁，大量饮酒和抑郁的斜率呈显著正相关，但在年轻年龄段则没有。尽管这些关联的强度不因组而异（有无 ADHD、儿童期或成年期），但在较年长年龄段，抑郁和大量饮酒的斜率变化很大，并且 ADHD 患者的抑郁增长速度明显更快，从 25 岁到 29 岁。
结论
由于 20 多岁后期成年人中大量饮酒和抑郁之间的关联增强，以及 ADHD 病史成年人的抑郁增加，因此患有 ADHD 的个体可能面临更高的共病抑郁和 binge 饮酒风险。随着这些个体进入人生的第四个十年，与负强化相关的饮酒可能会增强。需要更严格地测试这种可能性。
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