Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York.
Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.
Depress Anxiety. 2020 Jun;37(6):521-531. doi: 10.1002/da.23001. Epub 2020 Feb 14.
The course of anxiety disorders during childhood is heterogeneous. In two generations at high or low risk, we described the course of childhood anxiety disorders and evaluated whether parent or grandparent major depressive disorder (MDD) predicted a persistent anxiety course.
We utilized a multigenerational study (1982-2015), following children (second generation, G2) and grandchildren (third generation, G3) of generation 1 (G1) with either moderate/severe MDD or no psychiatric illness. Psychiatric diagnoses were based on diagnostic interviews. Using group-based trajectory models, we identified clusters of children with similar anxiety disorder trajectories (age 0-17).
We identified three primary trajectories in G2 (N = 275) and G3 (N = 118) cohorts: "no/low anxiety disorder" during childhood (G2 = 66%; G3 = 53%), "nonpersistent" with anxiety during part of childhood (G2 = 16%; G3 = 21%), and "persistent" (G2 = 18%; G3 = 25%). Childhood mood disorders and substance use disorders tended to be more prevalent in children in the persistent anxiety trajectory. In G2 children, parent MDD was associated with an increased likelihood of being in the persistent (84%) or nonpersistent trajectory (82%) versus no/low anxiety trajectory (62%). In G3 children, grandparent MDD, but not parent, was associated with an increased likelihood of being in the persistent (83%) versus nonpersistent (48%) and no/low anxiety (51%) trajectories.
Anxiety trajectories move beyond what is captured under binary, single time-point measures. Parent or grandparent history of moderate/severe MDD may offer value in predicting child anxiety disorder course, which could help clinicians and caregivers identify children needing increased attention and screening for other psychiatric conditions.
儿童期焦虑障碍的病程存在异质性。在两代高风险或低风险人群中，我们描述了儿童期焦虑障碍的病程，并评估了父母或（外）祖父母的重度抑郁症（MDD）是否能预测持续的焦虑病程。
我们利用了一项多代研究（1982-2015 年），随访了第一代（G1）中有中度/重度 MDD 或无精神疾病的孩子（第二代，G2）和孙辈（第三代，G3）。使用基于诊断访谈的方法进行精神疾病诊断。我们使用基于群组的轨迹模型，确定了具有相似焦虑障碍轨迹的儿童群组（年龄 0-17 岁）。
我们在 G2（N=275）和 G3（N=118）队列中确定了三个主要轨迹：儿童期“无/低焦虑障碍”（G2=66%；G3=53%）、儿童期部分时间存在“非持续性”焦虑（G2=16%；G3=21%）和“持续性”焦虑（G2=18%；G3=25%）。童年心境障碍和物质使用障碍在持续性焦虑轨迹的儿童中更为常见。在 G2 儿童中，父母的 MDD 与处于持续性（84%）或非持续性（82%）焦虑轨迹而非无/低焦虑轨迹（62%）的可能性增加相关。在 G3 儿童中，（外）祖父母的 MDD，而不是父母的 MDD，与处于持续性（83%）而非非持续性（48%）和无/低焦虑（51%）轨迹的可能性增加相关。
焦虑轨迹超出了基于二元、单次测量的捕捉范围。父母或（外）祖父母中重度 MDD 的病史可能有助于预测儿童焦虑障碍的病程，这可以帮助临床医生和护理人员识别需要增加关注和筛查其他精神疾病的儿童。
