Tracing the origins of midlife despair: association of psychopathology during adolescence with a syndrome of despair-related maladies at midlife.
Tracing the origins of midlife despair: association of psychopathology during adolescence with a syndrome of despair-related maladies at midlife.
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DOI：
10.1017/s0033291723001320
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发表时间：
2023-12
影响因子：
6.9
通讯作者：
Caspi, Avshalom
中科院分区：
文献类型：
--
作者：
Brennan, Grace M.;Moffitt, Terrie E.;Ambler, Antony;Harrington, HonaLee;Hogan, Sean;Houts, Renate M.;Mani, Ramakrishnan;Poulton, Richie;Ramrakha, Sandhya;Caspi, Avshalom
关键词：
中年成年人正经历着绝望死亡的危机（即死于自杀、药物过量和与酒精有关的肝病）。我们检验了这样一个假设，即在中年出现与绝望有关的疾病综合症之前，会出现青春期的精神病理。参与者是1972-73年在新西兰达尼丁出生的1037人的代表性队列的成员，随访至45岁，保留率为94%。青少年精神障碍在11岁、13岁和15岁时通过三种诊断评估进行评估。在45岁时，使用包括自我报告、举报人报告和国家登记数据在内的多模式测量方法评估了四个领域的绝望相关疾病指标——自杀、药物滥用、睡眠问题和疼痛。我们确定并验证了中年绝望相关疾病的综合征，包括自杀、药物滥用、睡眠问题和疼痛。在中年表现出更严重的绝望相关疾病综合征的成年人，即使在调整了性别、童年经济地位和童年智商之后，也倾向于出现早发性情绪和行为障碍[β = 0.23, 95% CI (0.16-0.30), p < 0.001]。在青少年时期被诊断患有精神障碍的成年人中，中年绝望综合症更为明显[β = 0.26, 95% CI (0.19-0.33), p < 0.001]。诊断特异性测试显示，这种关联在不同的青少年精神障碍中普遍存在。表现出更严重的绝望相关疾病综合症的中年成年人往往在青少年时期就患有精神病理学。青少年精神病理学的预防和治疗可以减轻与中年绝望有关的疾病，并最终减少绝望的死亡。
Midlife adults are experiencing a crisis of deaths of despair (i.e. deaths from suicide, drug overdose, and alcohol-related liver disease). We tested the hypothesis that a syndrome of despair-related maladies at midlife is preceded by psychopathology during adolescence. Participants are members of a representative cohort of 1037 individuals born in Dunedin, New Zealand in 1972–73 and followed to age 45 years, with 94% retention. Adolescent mental disorders were assessed in three diagnostic assessments at ages 11, 13, and 15 years. Indicators of despair-related maladies across four domains – suicidality, substance misuse, sleep problems, and pain – were assessed at age 45 using multi-modal measures including self-report, informant-report, and national register data. We identified and validated a syndrome of despair-related maladies at midlife involving suicidality, substance misuse, sleep problems, and pain. Adults who exhibited a more severe syndrome of despair-related maladies at midlife tended to have had early-onset emotional and behavioral disorders [β = 0.23, 95% CI (0.16–0.30), p < 0.001], even after adjusting for sex, childhood SES, and childhood IQ. A more pronounced midlife despair syndrome was observed among adults who, as adolescents, were diagnosed with a greater number of mental disorders [β = 0.26, 95% CI (0.19–0.33), p < 0.001]. Tests of diagnostic specificity revealed that associations generalized across different adolescent mental disorders. Midlife adults who exhibited a more severe syndrome of despair-related maladies tended to have had psychopathology as adolescents. Prevention and treatment of adolescent psychopathology may mitigate despair-related maladies at midlife and ultimately reduce deaths of despair.