Valleni-Basile L A, Garrison C Z, Waller J L, Addy C L, McKeown R E, Jackson K L, Cuffe S P
Department of Epidemiology and Biostatistics, University of South Carolina, Columbia 29208, USA.
J Am Acad Child Adolesc Psychiatry. 1996 Jul;35(7):898-906. doi: 10.1097/00004583-199607000-00015.
To investigate the incidence, transition probabilities, and risk factors for obsessive-compulsive disorder (OCD) and subclinical OCD in adolescents.
A two-stage epidemiological study originally designed to investigate depression was conducted between 1987 and 1989 in the southeastern United States. For the screening, a self-report depressive symptom questionnaire was administered to a community sample of 3,283 adolescents. In the diagnostic stage, the Schedule for Affective Disorders and Schizophrenia for School-Age Children was administered to 488 mother-child pairs. Baseline screening and diagnostic data from the first year the subject completed an interview and follow-up diagnostic data from subsequent years were used.
The 1-year incidence rates of OCD and subclinical OCD were found to be 0.7% and 8.4%, respectively. Transition probabilities demonstrated a pattern of moving from more severe to less severe categories. Of those with baseline OCD, 17% had the diagnosis of OCD at follow-up; 62% moved to the referent group. Of those with baseline subclinical OCD, 1.5% had OCD at follow-up and 75% moved to the referent group. Black race (odds ratio [OR] = 23.38), age (OR = 4.02), desirable life events (OR = 0.78), undesirable life events (OR = 1.21), and socioeconomic status (OR not estimable) were significant predictors of incident OCD. Age (OR = 2.30), desirable life events (OR = 0.92), and undesirable life events (OR = 1.13) were significantly associated with incident subclinical OCD.
An initial diagnosis of subclinical OCD was not significantly predictive of a diagnosis of OCD at 1-year follow-up. The overall morbidity remained higher at follow-up in the baseline OCD group than in the baseline subclinical OCD group. The baseline subclinical OCD group was more dysfunctional at follow-up than was the baseline referent group. Further research concerning differences in symptomatology and impairment between OCD and subclinical OCD is warranted.
调查青少年强迫症（OCD）及亚临床强迫症的发病率、转变概率和危险因素。
1987年至1989年在美国东南部开展了一项最初旨在调查抑郁症的两阶段流行病学研究。筛查时，对3283名青少年的社区样本进行了一份自填式抑郁症状问卷的调查。在诊断阶段，对488对母婴进行了学龄儿童情感障碍和精神分裂症量表的调查。使用了受试者完成首次访谈的第一年的基线筛查和诊断数据以及后续年份的随访诊断数据。
发现OCD和亚临床OCD的1年发病率分别为0.7%和8.4%。转变概率呈现出从较严重类别向较轻类别转变的模式。基线时患有OCD的患者中，17%在随访时仍被诊断为OCD；62%转变为参照组。基线时患有亚临床OCD的患者中，1.5%在随访时患有OCD，75%转变为参照组。黑人种族（比值比[OR]=23.38）、年龄（OR=4.02）、合意生活事件（OR=0.78）、不合意生活事件（OR=1.21）和社会经济地位（OR无法估计）是OCD发病的显著预测因素。年龄（OR=2.30）、合意生活事件（OR=0.92）和不合意生活事件（OR=1.13）与亚临床OCD发病显著相关。
亚临床OCD的初始诊断对1年随访时OCD诊断的预测性不显著。随访时，基线OCD组的总体发病率仍高于基线亚临床OCD组。随访时，基线亚临床OCD组比基线参照组功能障碍更严重。有必要对OCD和亚临床OCD在症状学和损害方面的差异进行进一步研究。
