Rosellini Anthony J, Szentkúti Péter, Horváth-Puhó Erzsébet, Smith Meghan L, Galatzer-Levy Isaac, Lash Timothy L, Galea Sandro, Schnurr Paula P, Sørensen Henrik T, Gradus Jaimie L
Center for Anxiety and Related Disorders, Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA.
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
J Psychiatr Res. 2021 Apr;136:334-342. doi: 10.1016/j.jpsychires.2021.02.013. Epub 2021 Feb 13.
Some narrow patterns of posttraumatic psychiatric comorbidity are well-established (e.g., posttraumatic stress disorder and substance use). However, broad multi-diagnosis profiles of posttraumatic comorbidity are poorly characterized. The goal of the current study was to use latent class analysis (LCA) to identify profiles of posttraumatic psychopathology from 11 International Classification of Diseases (ICD-10) diagnostic categories (e.g., stress, substance, depressive, psychosis, personality). Danish national registries were used to identify 166,539 individuals (median age = 41 years, range = <1 to >100) who experienced a traumatic event between 1994 and 2016 and were diagnosed with one or more mental disorders within 5 years. Two through 14-class LCA solutions were evaluated. A 13-class solution (a) provided the best fit, with the Bayes and Akaike Information Criteria reaching a minimum, (b) was broadly consistent with prior LCA studies, and (c) included several novel classes reflecting differential patterns of posttraumatic psychopathology. Three classes were characterized by high comorbidity: broad high comorbidity (M # diagnoses = 4.3), depression with stress/substance use/personality/neurotic disorders (M# diagnoses = 3.8), and substance use with personality/stress/psychotic disorders (M # diagnoses = 3.1). The other 10 classes were characterized by distinct patterns of mild comorbidity or negligible comorbidity. Compared to the mild and negligible comorbidity classes, individuals in high comorbidity classes were younger, had lower income, and had more pre-event psychiatric disorders. Results suggest that several different comorbidity patterns should be assessed when studying and treating posttraumatic psychopathology.
一些创伤后精神共病的狭窄模式已得到充分证实(例如,创伤后应激障碍和物质使用)。然而,创伤后共病的广泛多诊断概况却鲜有描述。本研究的目的是使用潜在类别分析(LCA)从11种国际疾病分类(ICD - 10)诊断类别(例如,应激、物质、抑郁、精神病、人格)中识别创伤后精神病理学概况。丹麦国家登记处用于识别166,539名个体(年龄中位数 = 41岁,范围 = <1至>100岁),他们在1994年至2016年期间经历了创伤性事件,并在5年内被诊断出患有一种或多种精神障碍。评估了2至14类的LCA解决方案。13类解决方案(a)提供了最佳拟合,贝叶斯和赤池信息准则达到最小值,(b)与先前的LCA研究大致一致,并且(c)包括几个反映创伤后精神病理学不同模式的新类别。三类的特征是高共病率:广泛高共病(平均诊断数 = 4.3)、伴有应激/物质使用/人格/神经症性障碍的抑郁症(平均诊断数 = 3.8)以及伴有人格/应激/精神病性障碍的物质使用(平均诊断数 = 3.1)。其他10类的特征是轻度共病或可忽略不计的共病的不同模式。与轻度和可忽略不计的共病类别相比,高共病类别中的个体更年轻,收入更低,并且事件前的精神障碍更多。结果表明,在研究和治疗创伤后精神病理学时,应评估几种不同的共病模式。