Lewinsohn P M, Rohde P, Seeley J R
Oregon Research Institute, Eugene 97403-1983, USA.
J Am Acad Child Adolesc Psychiatry. 1995 Apr;34(4):510-9. doi: 10.1097/00004583-199504000-00018.
To describe the clinical consequences associated with the lifetime occurrence of comorbid psychiatric disorders.
In a community sample of 1,507 older adolescents (aged 14 through 18 years), subjects with "pure" and comorbid forms of four major psychiatric disorders (depression, anxiety, substance use, and disruptive behavior) were compared on six clinical outcome measures.
The impact of comorbidity was strongest for academic problems, mental health treatment utilization, and past suicide attempts; intermediate on measures of role functioning and conflict with parents; and nonsignificant on physical symptoms. The greatest incremental impact of comorbidity was on anxiety disorders; the least was on substance use disorders. Although some patterns of comorbidity were much more common in boys (e.g., substance use and disruptive behavior disorder) or in girls (e.g., depression and anxiety), the impact of specific comorbid disorders on the clinical measures was not different for females and males. The effect of comorbidity was not due to current psychopathology.
The significance of comorbidity differs across specific comorbid disorders and across outcome measures, with some comorbid disorders being much more detrimental, and some outcome measures much more affected, than others.
描述与共病精神障碍终生发生相关的临床后果。
在一个由1507名年龄较大的青少年（14至18岁）组成的社区样本中，对患有四种主要精神障碍（抑郁症、焦虑症、物质使用障碍和破坏性行为障碍）的“单纯”形式和共病形式的受试者在六项临床结局指标上进行了比较。
共病对学业问题、心理健康治疗利用情况和既往自杀未遂的影响最为强烈；对角色功能和与父母冲突的指标影响中等；对身体症状无显著影响。共病的最大增量影响在焦虑症上；最小的是在物质使用障碍上。虽然某些共病模式在男孩（如物质使用障碍和破坏性行为障碍）或女孩（如抑郁症和焦虑症）中更为常见，但特定共病障碍对临床指标的影响在女性和男性中并无差异。共病的影响并非由于当前的精神病理学。
共病的重要性在特定的共病障碍和结局指标之间存在差异，一些共病障碍比其他障碍更具危害性，一些结局指标比其他指标受影响更大。
