Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.
J Child Psychol Psychiatry. 2019 Nov;60(11):1183-1190. doi: 10.1111/jcpp.13067. Epub 2019 May 2.
Internalising and externalising problems commonly co-occur in childhood. Yet, few developmental models describing the structure of child psychopathology appropriately account for this comorbidity. We evaluate a model of childhood psychopathology that separates the unique and shared contribution of individual psychological symptoms into specific internalising, externalising and general psychopathology factors and assess how these general and specific factors predict long-term outcomes concerning criminal behaviour, academic achievement and affective symptoms in three independent cohorts.
Data were drawn from independent birth cohorts (Avon Longitudinal Study of Parents and Children (ALSPAC), N = 11,612; Generation R, N = 7,946; Maternal Adversity, Vulnerability and Neurodevelopment (MAVAN), N = 408). Child psychopathology was assessed between 4 and 8 years using a range of diagnostic and questionnaire-based measures, and multiple informants. First, structural equation models were used to assess the fit of hypothesised models of shared and unique components of psychopathology in all cohorts. Once the model was chosen, linear/logistic regressions were used to investigate whether these factors were associated with important outcomes such as criminal behaviour, academic achievement and well-being from late adolescence/early adulthood.
The model that included specific factors for internalising/externalising and a general psychopathology factor capturing variance shared between symptoms regardless of their classification fits well for all of the cohorts. As hypothesised, general psychopathology factor scores were predictive of all outcomes of later functioning, while specific internalising factor scores predicted later internalising outcomes. Specific externalising factor scores, capturing variance not shared by any other psychological symptoms, were not predictive of later outcomes.
Early symptoms of psychopathology carry information that is syndrome-specific as well as indicative of general vulnerability and the informant reporting on the child. The 'general psychopathology factor' might be more relevant for long-term outcomes than specific symptoms. These findings emphasise the importance of considering the co-occurrence of common internalising and externalising problems in childhood when considering long-term impact.
儿童时期常见的内化和外化问题同时存在。然而，很少有发展模型能够恰当地描述儿童精神病理学的结构，以说明这种共病现象。我们评估了一种儿童精神病理学模型，该模型将个体心理症状的独特和共同贡献分离为特定的内化、外化和一般精神病理学因素，并评估这些一般和特定因素如何在三个独立队列中预测长期结果，包括犯罪行为、学业成绩和情感症状。
数据来自独立的出生队列（阿冯纵向研究父母和儿童（ALSPAC），N=11612；生育研究，N=7946；母亲逆境、脆弱性和神经发育（MAVAN），N=408）。在 4 至 8 岁之间，使用一系列诊断和基于问卷的测量方法以及多个信息来源评估儿童精神病理学。首先，结构方程模型用于评估所有队列中精神病理学共享和独特成分的假设模型的拟合度。一旦选择了模型，线性/逻辑回归用于研究这些因素是否与犯罪行为、学业成绩和青春期后期/成年早期的幸福感等重要结果相关。
包含内化/外化特定因素和一般精神病理学因素的模型，该因素可以捕获症状之间无论其分类如何的共享方差，适合所有队列。正如假设的那样，一般精神病理学因素得分可以预测所有后续功能的结果，而特定的内化因素得分则可以预测后续的内化结果。特定的外化因素得分，捕获任何其他心理症状都不共享的方差，与后续结果无关。
早期精神病理学症状不仅具有特定综合征的信息，还具有一般脆弱性和儿童报告者的信息。“一般精神病理学因素”可能比特定症状更能反映长期结果。这些发现强调了在考虑儿童时期常见的内化和外化问题对长期影响时，考虑共病的重要性。
