King C A, Ghaziuddin N, McGovern L, Brand E, Hill E, Naylor M
Department of Psychiatry, University of Michigan, Ann Arbor, USA.
J Am Acad Child Adolesc Psychiatry. 1996 Jun;35(6):743-51. doi: 10.1097/00004583-199606000-00014.
To identify clinical profiles discriminating depressed adolescents on the basis of comorbid alcohol/substance use disorders and to determine whether or not profiles with high predictive power are gender-specific.
One hundred three adolescent inpatients with major depression (65 girls, 38 boys) participated in a comprehensive diagnostic evaluation. Independent assessments of depression, suicidality, and psychosocial adjustment were conducted using well-validated instruments.
Gender-specific clinical profiles were identified that predicted alcohol/substance abuse in depressed adolescents with high levels of sensitivity (90%). The significant discriminant function for depressed girls included the following predictors: longer depressive episodes, more conduct problems and psychosocial impairment, and more active involvement in relationships with boys. The significant discriminant function for depressed boys included conduct disorder, older age, and schoolwork problems. These profiles correctly identified most depressed adolescents with comorbid alcohol/substance abuse.
Given that alcohol abuse and depression are associated with highly impaired social functioning and increased risk of self-harm, sensitivity in case identification is critical. Clinicians should conduct comprehensive assessments of alcohol/substance abuse in depressed adolescents with the identified clinical profiles.
基于共病的酒精/物质使用障碍来识别区分抑郁青少年的临床特征，并确定具有高预测力的特征是否具有性别特异性。
103名患有重度抑郁症的青少年住院患者（65名女孩，38名男孩）参与了一项全面的诊断评估。使用经过充分验证的工具对抑郁、自杀倾向和心理社会适应进行了独立评估。
确定了具有性别特异性的临床特征，这些特征对抑郁青少年中的酒精/物质滥用具有高度敏感性（90%）的预测能力。抑郁女孩的显著判别函数包括以下预测因素：抑郁发作时间更长、更多的行为问题和心理社会损害，以及更积极地参与与男孩的关系。抑郁男孩的显著判别函数包括品行障碍、年龄较大和学业问题。这些特征正确地识别了大多数患有共病酒精/物质滥用的抑郁青少年。
鉴于酒精滥用和抑郁症与严重受损的社会功能以及更高的自我伤害风险相关，病例识别的敏感性至关重要。临床医生应对具有已确定临床特征的抑郁青少年进行酒精/物质滥用的全面评估。
