从学龄前到青春期早期,易怒、对立、抑郁和焦虑问题的跨诊断轨迹。
Transdiagnostic trajectories of irritability and oppositional, depression and anxiety problems from preschool to early adolescence.
作者信息
Ezpeleta Lourdes, Penelo Eva, Navarro J Blas, Osa Núria de la, Trepat Esther
机构信息
Unitat d'Epidemiologia i de Diagnòstic en Psicopatologia del Desenvolupament, Universitat Autònoma de Barcelona, 08193, Bellaterra, Barcelona, Spain; Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, 08193, Bellaterra, Barcelona, Spain.
Unitat d'Epidemiologia i de Diagnòstic en Psicopatologia del Desenvolupament, Universitat Autònoma de Barcelona, 08193, Bellaterra, Barcelona, Spain; Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, 08193, Bellaterra, Barcelona, Spain.
出版信息
Behav Res Ther. 2020 Nov;134:103727. doi: 10.1016/j.brat.2020.103727. Epub 2020 Sep 12.
Irritability is a transdiagnostic symptom in oppositional defiant disorder, depression, and anxiety, all highly comorbid disorders but with unknown simultaneous evolution. The aim was to obtain the developmental trajectories of simultaneous irritability and oppositional, depression, and anxiety problems from preschool age to early adolescence. A sample of 493 community children was followed up annually from ages 3-11 years and assessed using categorical and dimensional measures answered by parents and teachers. Latent Class Growth Analysis for four parallel processes was used to identify distinct groups of individual trajectories for irritability and oppositional, depression, and anxiety problems. Outcomes at ages 11 and 12 were compared among trajectories using regression models and multiple comparisons. A 3-class model showed the highest entropy (0.961) and adequate posterior probabilities of class membership (≥0.969). Class 1 (n = 331, 67.1%) was made up of children with stable low scores in all the variables; class 2 (n = 55, 11.2%) of children with high depression, anxiety, and irritability and above the mean stable profiles for oppositional problems; and class 3 (n = 107, 21.7%) of children with medium-high increasing irritability and oppositional problems and on the mean depression and anxiety. The classes with symptomatology and irritability (2 and 3) clearly differed from class 1 (low) at baseline and in outcomes. The course of irritability and oppositional, depression, and anxiety problems from ages 3-11 years differed qualitatively and quantitatively across subgroups of children. The 3 classes identified may help to guide clinicians' decision-making regarding treating irritability and its comorbid disorders.
易激惹是对立违抗障碍、抑郁症和焦虑症中的一种跨诊断症状,这些疾病共病率都很高,但同时发展的情况尚不清楚。目的是获取从学龄前到青春期早期易激惹与对立、抑郁和焦虑问题同时出现的发展轨迹。对493名社区儿童进行了抽样,从3至11岁每年进行随访,并使用家长和教师回答的分类和维度测量方法进行评估。采用四个平行过程的潜在类别增长分析来识别易激惹与对立、抑郁和焦虑问题的不同个体轨迹组。使用回归模型和多重比较对各轨迹在11岁和12岁时的结果进行比较。一个3类别模型显示出最高的熵(0.961)和足够的类别归属后验概率(≥0.969)。第1类(n = 331,67.1%)由所有变量得分稳定较低的儿童组成;第2类(n = 55,11.2%)由抑郁、焦虑和易激惹程度高且对立问题高于平均稳定水平的儿童组成;第3类(n = 107,21.7%)由易激惹和对立问题中等偏高且抑郁和焦虑处于平均水平的儿童组成。有症状和易激惹的类别(2和3)在基线和结果方面与第1类(低)明显不同。3至11岁儿童亚组中易激惹与对立、抑郁和焦虑问题的发展过程在质量和数量上存在差异。所确定的3个类别可能有助于指导临床医生在治疗易激惹及其共病障碍方面的决策。