Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Zhou, Lageborn, Sjölander, Larsson, Landén, Lichtenstein, Pettersson); Department of Psychological and Brain Sciences, Indiana University, Bloomington (D'Onofrio); Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden (Landén).
Am J Psychiatry. 2024 Aug 1;181(8):761-773. doi: 10.1176/appi.ajp.20230353.
Associations were examined between six psychiatric diagnoses in parents and a broad range of psychiatric and nonpsychiatric outcomes in their offspring.
All individuals born in Sweden between 1970 and 2000 were linked to their biological parents (N=3,286,293) through Swedish national registers. A matched cohort design, with stratified Cox regression and conditional logistic regression analyses, was used examine associations between six psychiatric diagnoses in the parents and 32 outcomes in their offspring. All children, including those exposed and those not exposed to parents with psychiatric diagnoses, were followed from their date of birth to the date of emigration from Sweden, death, or December 31, 2013, when the offspring were 14-44 years old.
In terms of absolute risk, most children who had parents with psychiatric diagnoses were not diagnosed in specialist care themselves, and the proportion of offspring having any of the 16 types of psychiatric conditions ranged from 22.17% (of offspring exposed to parental depression) to 25.05% (of offspring exposed to parental drug-related disorder) at the end of follow-up. Nevertheless, in terms of relative risk, exposure to any of the six parental psychiatric diagnoses increased probabilities of the 32 outcomes among the offspring, with hazard ratios that ranged from 1.03 to 8.46 for time-to-event outcomes and odds ratios that ranged from 1.29 to 3.36 for binary outcomes. Some specificities were observed for parental diagnoses of psychosis and substance-related disorders, which more strongly predicted psychotic-like and externalizing-related outcomes, respectively, in the offspring.
The intergenerational transmission of parental psychiatric conditions appeared largely transdiagnostic and extended to nonpsychiatric outcomes in offspring. Given the broad spectrum of associations with the outcomes, service providers (e.g., psychiatrists, teachers, and social workers) should consider clients' broader psychiatric family history when predicting prognosis and planning interventions or treatment.
探讨父母的六种精神科诊断与子女广泛的精神科和非精神科结局之间的关联。
通过瑞典国家登记册将 1970 年至 2000 年期间出生的所有个体与其亲生父母（n=3286293）进行关联。采用匹配队列设计，采用分层 Cox 回归和条件逻辑回归分析，检验父母的六种精神科诊断与子女的 32 种结局之间的关联。所有儿童，包括暴露于父母患有精神科诊断和未暴露于父母患有精神科诊断的儿童，均从出生之日起随访至移民离开瑞典、死亡或 2013 年 12 月 31 日，此时子女年龄为 14-44 岁。
从绝对风险来看，大多数父母患有精神科诊断的子女本身并未在专科医疗机构中得到诊断，并且在随访结束时，有 16 种精神科疾病类型之一的子女比例从父母抑郁暴露的 22.17%（子女暴露于父母抑郁）到父母药物相关障碍暴露的 25.05%（子女暴露于父母药物相关障碍）不等。然而，从相对风险来看，暴露于父母的六种精神科诊断之一会增加子女发生 32 种结局的可能性，其时间事件结局的危害比范围为 1.03 至 8.46，二元结局的优势比范围为 1.29 至 3.36。对于父母的精神病诊断和物质相关障碍诊断，观察到一些特异性，这两种诊断分别更强烈地预测子女的类精神病和外化相关结局。
父母精神科疾病的代际传递似乎在很大程度上是跨诊断的，并延伸到子女的非精神科结局。鉴于与结局的广泛关联，服务提供者（如精神科医生、教师和社会工作者）在预测预后和规划干预或治疗时，应考虑客户更广泛的精神科家族史。
