CORE-Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark.
The Lundbeck Foundation Initiative for Integrative Psychiatric Research-iPSYCH, Aarhus, Denmark.
J Child Psychol Psychiatry. 2022 Sep;63(9):1046-1056. doi: 10.1111/jcpp.13548. Epub 2021 Dec 16.
Children at familial high-risk of schizophrenia and bipolar disorder have an elevated prevalence of mental disorders but studies of children within a narrow age range are lacking and there are few conjoint studies of these two groups. Knowledge on their mental health is important for prevention and early intervention.
The authors examined mental disorders and global functioning in children at familial high-risk of schizophrenia (FHR-SZ) and bipolar disorder (FHR-BP) compared with population-based controls. In a longitudinal cohort study, 450 children (FHR-SZ, n = 171; FHR-BP, n = 104; controls, n = 175), were assessed for Axis I disorders at baseline and four-year follow-up (mean age 11.9, SD 0.2) with the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children and for global functioning with Children's Global Assessment Scale.
Cumulative incidence of Any Axis I disorder was elevated by age 11 in children at FHR-SZ (54.4%, OR 3.0, 95% CI 1.9-4.7, p < .001) and children at FHR-BP (52.9%, OR 2.8, 95% CI 1.7-4.7, p < .001) compared with controls (28.6%). Children at FHR-SZ and FHR-BP had higher rates of affective disorders (OR 4.4, 95% CI 1.4-13.5, p = .009; OR 5.1, 95% CI 1.6-16.4, p = .007), anxiety disorders (OR 2.1, 95% CI 1.1-4.0, p = .02; OR 3.0, 95% CI 1.5-6.1, p = .002), and stress and adjustment disorders (OR 3.3, 95% CI 1.4-7.5, p = .006; OR 5.3, 95% CI 2.2-12.4, p < .001). Disruptive behavior disorders (OR 2.8, 95% CI 1.0-7.3, p = .04) and ADHD (OR 2.9, 95% CI 1.6-5.3, p < .001) were elevated in children at FHR-SZ. Both FHR groups had lower global functioning than controls. Cumulative incidence of disorders increased equally across the three groups from early childhood to preadolescence and level of functioning did not change differentially.
Children at FHR-SZ and FHR-BP have an elevated prevalence of mental disorders and poorer functioning than controls. Vulnerability in children at FHR manifests early and remains stable throughout childhood. Early attention toward their mental health and identification of those in need of intervention is warranted.
患有精神分裂症和双相情感障碍家族高风险的儿童精神障碍患病率较高，但目前缺乏对年龄范围较窄的儿童的研究，且这两组人群的联合研究较少。了解他们的心理健康状况对于预防和早期干预至关重要。
作者比较了精神分裂症家族高风险（FHR-SZ）和双相情感障碍家族高风险（FHR-BP）儿童与基于人群的对照组儿童的精神障碍和总体功能。在一项纵向队列研究中，在基线和四年随访（平均年龄 11.9，SD 0.2）时，使用儿童情绪障碍和精神分裂症量表对 450 名儿童（FHR-SZ，n=171；FHR-BP，n=104；对照组，n=175）进行了轴 I 障碍评估，使用儿童总体评估量表进行了总体功能评估。
在 11 岁时，FHR-SZ（54.4%，OR 3.0，95%CI 1.9-4.7，p<0.001）和 FHR-BP（52.9%，OR 2.8，95%CI 1.7-4.7，p<0.001）儿童的任何轴 I 障碍累积发生率均高于对照组（28.6%）。FHR-SZ 和 FHR-BP 儿童的情感障碍（OR 4.4，95%CI 1.4-13.5，p=0.009；OR 5.1，95%CI 1.6-16.4，p=0.007）、焦虑障碍（OR 2.1，95%CI 1.1-4.0，p=0.02；OR 3.0，95%CI 1.5-6.1，p=0.002）和压力及适应障碍（OR 3.3，95%CI 1.4-7.5，p=0.006；OR 5.3，95%CI 2.2-12.4，p<0.001）的发生率更高。FHR-SZ 儿童的破坏性行为障碍（OR 2.8，95%CI 1.0-7.3，p=0.04）和 ADHD（OR 2.9，95%CI 1.6-5.3，p<0.001）的发生率也较高。与对照组相比，两组 FHR 儿童的总体功能均较低。从幼儿期到青春期前，三组的疾病累积发生率均呈上升趋势，功能水平差异无统计学意义。
FHR-SZ 和 FHR-BP 儿童的精神障碍患病率和功能水平均较对照组儿童高。FHR 儿童的易感性很早就表现出来，并在整个儿童期保持稳定。需要早期关注他们的心理健康状况，并确定需要干预的人群。
