Pines Adam, Tozzi Leonardo, Bertrand Claire, Keller Arielle S, Zhang Xue, Whitfield-Gabrieli Susan, Hastie Trevor, Larsen Bart, Leikauf John, Williams Leanne M
Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California.
Penn Lifespan Informatics and Neuroimaging Center, University of Pennsylvania, Philadelphia.
JAMA Psychiatry. 2024 Dec 1;81(12):1236-1245. doi: 10.1001/jamapsychiatry.2024.2399.
Mental illnesses are a leading cause of disability globally, and functional disability is often in part caused by cognitive impairments across psychiatric disorders. However, studies have consistently reported seemingly opposite findings regarding the association between cognition and psychiatric symptoms.
To determine if the association between general cognition and mental health symptoms diverges at different symptom severities in children.
DESIGN, SETTING, AND PARTICIPANTS: A total of 5175 children with complete data at 2 time points assessed 2 years apart (aged 9 to 11 years at the first assessment) from the ongoing Adolescent Brain and Cognitive Development (ABCD) study were evaluated for a general cognition factor and mental health symptoms from September 2016 to August 2020 at 21 sites across the US. Polynomial and generalized additive models afforded derivation of continuous associations between cognition and psychiatric symptoms across different ranges of symptom severity. Data were analyzed from December 2022 to April 2024.
Aggregate cognitive test scores (general cognition) were primarily evaluated in relation to total and subscale-specific symptoms reported from the Child Behavioral Checklist.
The sample included 5175 children (2713 male [52.4%] and 2462 female [47.6%]; mean [SD] age, 10.9 [1.18] years). Previously reported mixed findings regarding the association between general cognition and symptoms may consist of several underlying, opposed associations that depend on the class and severity of symptoms. Linear models recovered differing associations between general cognition and mental health symptoms, depending on the range of symptom severities queried. Nonlinear models confirm that internalizing symptoms were significantly positively associated with cognition at low symptom burdens higher cognition = more symptoms) and significantly negatively associated with cognition at high symptom burdens.
The association between mental health symptoms and general cognition in this study was nonlinear. Internalizing symptoms were both positively and negatively associated with general cognition at a significant level, depending on the range of symptom severities queried in the analysis sample. These results appear to reconcile mixed findings in prior studies, which implicitly assume that symptom severity tracks linearly with cognitive ability across the entire spectrum of mental health. As the association between cognition and symptoms may be opposite in low vs high symptom severity samples, these results reveal the necessity of clinical enrichment in studies of cognitive impairment.
精神疾病是全球致残的主要原因，功能残疾往往部分是由各种精神障碍中的认知障碍引起的。然而，关于认知与精神症状之间的关联，研究一直报告出看似相反的结果。
确定儿童中一般认知与心理健康症状之间的关联在不同症状严重程度下是否存在差异。
设计、背景和参与者：从正在进行的青少年大脑与认知发展（ABCD）研究中，选取了5175名在两个时间点（相隔2年评估）有完整数据的儿童（首次评估时年龄为9至11岁），于2016年9月至2020年8月在美国的21个地点对其一般认知因素和心理健康症状进行评估。多项式和广义相加模型用于推导不同症状严重程度范围内认知与精神症状之间的连续关联。数据于2022年12月至2024年4月进行分析。
综合认知测试分数（一般认知）主要根据儿童行为清单报告的总症状和特定子量表症状进行评估。
样本包括5175名儿童（2713名男性[52.4%]和2462名女性[47.6%]；平均[标准差]年龄为10.9[1.18]岁）。先前关于一般认知与症状之间关联的混合研究结果可能包含几种潜在的、相反的关联，这取决于症状的类别和严重程度。线性模型根据所查询的症状严重程度范围，得出了一般认知与心理健康症状之间不同的关联。非线性模型证实，内化症状在低症状负担时与认知显著正相关（认知水平越高，症状越多），而在高症状负担时与认知显著负相关。
本研究中，心理健康症状与一般认知之间的关联是非线性的。内化症状在显著水平上与一般认知既呈正相关又呈负相关，这取决于分析样本中所查询的症状严重程度范围。这些结果似乎调和了先前研究中的混合结果，先前研究隐含地假设症状严重程度在整个心理健康范围内与认知能力呈线性相关。由于在低症状严重程度样本与高症状严重程度样本中，认知与症状之间的关联可能相反，这些结果揭示了在认知障碍研究中进行临床富集的必要性。
