Prodromes and precursors: epidemiologic data for primary prevention of disorders with slow onset.
Prodromes and precursors: epidemiologic data for primary prevention of disorders with slow onset.
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DOI：
10.1176/ajp.152.7.967
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发表时间：
1995-07
期刊：
影响因子：
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通讯作者：
W. Eaton;M. Badawi;Beth Melton
中科院分区：
文献类型：
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作者：
W. Eaton;M. Badawi;Beth Melton
目的用前驱症状和前兆的概念来说明如何利用发病年龄的流行病学数据来确定预防干预的时间和选择目标人群。方法有关DSM-III抑郁症和惊恐障碍发病的资料来自流行病学集水区项目。累积分布的发病年龄诊断和发病的前兆，并引入归因风险的概念。归因风险是指如果干预措施在消除特定前体方面100%有效，则可以预防的病例的最大比例。结果抑郁症和恐慌的说明性结果。前驱物在预测完全障碍发作的程度上各不相同;在完全抑郁症之前的一年中有2周或更长时间的悲伤情绪是比体重减轻或增加（相对比值，3.0）更好的预测因素（相对比值，7.0）。人口归因风险的公式被应用到前体的相对风险和患病率，以估计潜在的成功的干预措施，为特定的前体预防疾病。前体归因风险表明，睡眠问题将确定47%的新病例的严重抑郁症发生在第二年，和问题“你是一个紧张的人吗？“将于下一年识别出百分之六十的恐慌症患者。结论：这个概念框架将疾病的早期自然史与寻找综合征联系起来。关于前体流行情况和可归因风险的知识，结合其他宿主特征和环境风险因素，可用于筛查和预防。
OBJECTIVE The concepts of prodrome and precursor are used to show how epidemiologic data on age at onset can be used in timing preventive interventions and selecting target populations. METHODS Data concerning onset of DSM-III major depression and panic disorder were taken from the Epidemiologic Catchment Area Program. Cumulative distributions of ages at onset of diagnosis and onset of precursors are presented, and the concept of attributable risk is introduced. Attributable risk is the maximum proportion of cases that would be prevented if an intervention were 100% effective in eliminating a specific precursor. RESULTS Illustrative results for depression and panic are presented. Precursors vary in the degree to which they predict onset of the full disorder; 2 or more weeks of sad mood in the year before full-blown depression is a better predictor (relative odds, 7.0) than weight loss or gain (relative odds, 3.0). The formula for population attributable risk was applied to the precursor relative risks and prevalences to estimate the potential success of interventions for specific precursors in preventing the disorder. The precursor attributable risks indicate that sleep problems would identify 47% of the new cases of major depression occurring in the following year, and the question "Are you a nervous person?" would identify 60% of persons with onset of panic disorder in the following year. CONCLUSIONS This conceptual framework links the early natural history of disorders with the search for syndromes. Knowledge of precursor prevalence and attributable risk, combined with other host characteristics and environmental risk factors, can be used in screening and prevention.