Division of Psychology and Language Sciences, University College London, UK.
University of Cambridge, UK.
J Am Acad Child Adolesc Psychiatry. 2019 Aug;58(8):776-786. doi: 10.1016/j.jaac.2018.11.011. Epub 2019 Jan 14.
Recent research suggests that comorbidity in child and adolescent psychiatric symptoms can be summarized by a single latent dimension known as the p factor and more specific factors summarizing clusters of symptoms. This study investigated within- and between-person changes in general and specific psychopathology factors over a psychosocial intervention.
A secondary analysis was conducted of the Systemic Therapy for At-Risk Teens study, a pragmatic randomized controlled trial that compared the effects of multisystemic therapy with those of management as usual for decreasing antisocial behavior in 684 adolescents (82% boys; 11-18 years old at baseline) over an 18-month period. The general p factor and specific antisocial, attention, anxiety, and mood factors were estimated from a symptom-level analysis of a set of narrowband symptom scales measured repeatedly during the study. General and specific psychopathology factors were assessed for reliability, validity, and within- and between-person change using a parallel process multilevel growth model.
A revised bi-factor model that included a general p factor and specific anxiety, mood, antisocial, and attention factors with cross-loadings fit the data best. Although the factor structure was multidimensional, the p factor accounted for most of the variance in total scores. The p factor, anxiety, and antisocial factors predicted within-person variation in external outcomes. Furthermore, the p factor and antisocial factors showed within-person declines, whereas anxiety showed within-person increases, over time. Despite individual variation in baseline factor scores, adolescents showed similar rates of change.
The bi-factor model is useful for teasing apart general and specific therapeutic changes that are conflated in standard analyses of symptom scores.
START (Systemic Therapy for At Risk Teens): A National Randomised Controlled Trial to Evaluate Multisystemic Therapy in the UK Context; http://www.isrctn.com; ISRCTN77132214.
最近的研究表明，儿童和青少年精神症状的合并症可以用一个单一的潜在维度来概括，称为 p 因子，以及更具体的概括症状群的因子。本研究调查了心理社会干预过程中一般和特定精神病理学因素的个体内和个体间变化。
对风险青少年系统治疗研究进行了二次分析，这是一项实用的随机对照试验，比较了多系统治疗与常规管理对减少 684 名青少年（82%为男性；基线时年龄为 11-18 岁）反社会行为的影响，研究时间为 18 个月。从研究期间反复测量的一组窄带症状量表的症状水平分析中，估计了一般的 p 因子和特定的反社会、注意力、焦虑和情绪因子。使用平行过程多层次增长模型评估了一般和特定精神病理学因素的可靠性、有效性以及个体内和个体间的变化。
一个包含一般的 p 因子和特定的焦虑、情绪、反社会和注意力因子的修订双因子模型，具有交叉负荷，最适合拟合数据。尽管因子结构是多维的，但 p 因子解释了总分的大部分变异。p 因子、焦虑和反社会因子预测了个体内外部结果的变化。此外，p 因子和反社会因子随时间表现出个体内下降，而焦虑则表现出个体内增加。尽管个体在基线因子得分上存在差异，但青少年的变化率相似。
双因子模型对于区分标准症状评分分析中混淆的一般和特定治疗变化很有用。
START（有风险的青少年的系统治疗）：在英国背景下评估多系统治疗的全国随机对照试验；http://www.isrctn.com；ISRCTN77132214。
