Duke Aging Center, Duke University School of Medicine, Durham, NC, USA.
Department of Psychology & Neuroscience, Duke University, Durham, NC, USA.
Psychol Med. 2023 Dec;53(16):7569-7580. doi: 10.1017/S0033291723001320. Epub 2023 May 10.
Midlife adults are experiencing a crisis of deaths of despair (i.e. deaths from suicide, drug overdose, and alcohol-related liver disease). We tested the hypothesis that a syndrome of despair-related maladies at midlife is preceded by psychopathology during adolescence.
Participants are members of a representative cohort of 1037 individuals born in Dunedin, New Zealand in 1972-73 and followed to age 45 years, with 94% retention. Adolescent mental disorders were assessed in three diagnostic assessments at ages 11, 13, and 15 years. Indicators of despair-related maladies across four domains - suicidality, substance misuse, sleep problems, and pain - were assessed at age 45 using multi-modal measures including self-report, informant-report, and national register data.
We identified and validated a syndrome of despair-related maladies at midlife involving suicidality, substance misuse, sleep problems, and pain. Adults who exhibited a more severe syndrome of despair-related maladies at midlife tended to have had early-onset emotional and behavioral disorders [ = 0.23, 95% CI (0.16-0.30), < 0.001], even after adjusting for sex, childhood SES, and childhood IQ. A more pronounced midlife despair syndrome was observed among adults who, as adolescents, were diagnosed with a greater number of mental disorders [ = 0.26, 95% CI (0.19-0.33), < 0.001]. Tests of diagnostic specificity revealed that associations generalized across different adolescent mental disorders.
Midlife adults who exhibited a more severe syndrome of despair-related maladies tended to have had psychopathology as adolescents. Prevention and treatment of adolescent psychopathology may mitigate despair-related maladies at midlife and ultimately reduce deaths of despair.
中年成年人正经历着绝望死亡（即自杀、药物过量和与酒精相关的肝病导致的死亡）的危机。我们检验了这样一个假设，即在中年出现与绝望相关的多种疾病之前，青少年时期存在心理病理学。
参与者是新西兰达尼丁 1972-73 年出生的代表性队列 1037 名个体的成员，随访至 45 岁，保留率为 94%。在 11、13 和 15 岁时进行了三次诊断评估，以评估青少年时期的精神障碍。使用多模态措施，包括自我报告、知情人报告和国家登记数据，在 45 岁时评估了四个领域的与绝望相关的多种疾病指标——自杀意念、物质滥用、睡眠问题和疼痛。
我们确定并验证了中年与绝望相关的多种疾病的综合征，该综合征涉及自杀意念、物质滥用、睡眠问题和疼痛。在中年表现出更严重的与绝望相关的多种疾病综合征的成年人往往存在早期出现的情绪和行为障碍[ = 0.23，95%置信区间（0.16-0.30）， < 0.001]，即使在调整了性别、儿童期社会经济地位和儿童期智商后也是如此。在青少年时期被诊断出患有更多精神障碍的成年人中，观察到更为明显的中年绝望综合征[ = 0.26，95%置信区间（0.19-0.33）， < 0.001]。诊断特异性测试表明，关联普遍存在于不同的青少年精神障碍中。
在中年表现出更严重的与绝望相关的多种疾病综合征的成年人往往在青少年时期就存在心理病理学。预防和治疗青少年心理病理学可能会减轻中年与绝望相关的多种疾病，并最终减少绝望死亡。
