Orygen, Parkville, Australia.
Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.
Transl Psychiatry. 2023 Mar 29;13(1):103. doi: 10.1038/s41398-023-02396-4.
Staging models with transdiagnostic validity across mood, psychotic, and anxiety disorders could advance early intervention efforts as well as our understanding of the common underpinnings of such psychopathology. However, there are few well-supported operationalisations for such transdiagnostic models, particularly in community-based samples. We aimed to explore the inter-relationships among mood, psychotic, and anxiety symptom stages, and their common risk factors to develop data-informed transdiagnostic stages. We included participants from the Avon Longitudinal Study of Parents and Children (ALSPAC), a prospective ongoing birth cohort study. We developed operational thresholds for stages of depressive, hypomanic, anxiety, and psychotic symptoms based on the existing literature, refined further by expert consensus. We selected 1b level as the primary stage or outcome of interest. This represents moderate symptoms that are likely to be associated with the onset of the need for clinical mental health care. We used questionnaire and clinic data completed by young people ages 18 and 21 years. We used descriptive methods and network analyses to examine the overlap among Stage 1b psychopathology. We then examined the patterns of relationships between several risk factors and 1b stages using logistic regressions. Among 3269 young people with data available to determine all symptom stages, 64.3% were female and 96% Caucasian. Descriptive and network analyses indicated that 1b level depressive, anxiety, and psychotic symptom stages were inter-related while hypomania was not. Similarly, anxiety, depressive, and psychotic 1b stages were associated with the female sex, more emotional and behavioral difficulties in early adolescence, and life events in late adolescence. Hypomania was not related to any of these risk factors. Given their inter-relationships and similar risk factors, anxiety, psychotic and depressive, symptoms could be combined to form a transdiagnostic stage in this cohort. Such empirical transdiagnostic stages could help with prognostication and indicated prevention in youth mental health.
具有跨诊断有效性的分期模型可以推进早期干预工作，以及我们对这种精神病理学共同基础的理解。然而，很少有得到充分支持的跨诊断模型的操作化方法，特别是在社区样本中。我们旨在探索情绪、精神病和焦虑症状分期之间的相互关系，以及它们的共同风险因素，以开发数据驱动的跨诊断分期。我们包括了来自阿冯纵向研究父母和儿童（ALSPAC）的参与者，这是一项正在进行的前瞻性出生队列研究。我们根据现有文献为抑郁、轻躁狂、焦虑和精神病症状的分期制定了操作阈值，并通过专家共识进一步完善。我们选择 1b 级作为主要分期或感兴趣的结果。这代表了中度症状，可能与需要临床心理健康护理的开始相关。我们使用问卷调查和诊所数据，这些数据由 18 岁和 21 岁的年轻人完成。我们使用描述性方法和网络分析来检查 1b 级精神病理学之间的重叠。然后，我们使用逻辑回归检查几个风险因素与 1b 分期之间的关系模式。在 3269 名有数据可确定所有症状分期的年轻人中，64.3%是女性，96%是白种人。描述性和网络分析表明，1b 级抑郁、焦虑和精神病症状分期相互关联，而轻躁狂则不然。同样，焦虑、抑郁和精神病 1b 分期与女性、青少年早期更多的情绪和行为困难以及青少年晚期的生活事件有关。轻躁狂与这些风险因素都没有关系。鉴于它们的相互关系和相似的风险因素，焦虑、精神病和抑郁症状可以在这个队列中组合成一个跨诊断分期。这种经验性的跨诊断分期可以帮助预测和指示青少年心理健康。
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