Adult Functional Outcomes of Common Childhood Psychiatric Problems: A Prospective, Longitudinal Study.
Adult Functional Outcomes of Common Childhood Psychiatric Problems: A Prospective, Longitudinal Study.
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DOI：
10.1001/jamapsychiatry.2015.0730
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发表时间：
2015-09
期刊：
影响因子：
25.8
通讯作者：
Costello EJ
中科院分区：
文献类型：
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作者：
Copeland WE;Wolke D;Shanahan L;Costello EJ
精神问题是儿童最常见的健康问题之一。测试这些健康问题是否会对成年人的功能产生不利影响，即使这些问题本身并不持续存在。前瞻性，基于人群的研究，1420名参与者在儿童期（9至16岁; 6674个观察结果）进行了6次结构化访谈，以评估常见的精神病诊断和阈下精神病问题。社区样本。然后，在年轻的成年期（19岁、21岁和24-26岁; 1273名受试者的3215次观察结果）对参与者进行了3次评估，以了解与健康、法律的、财务和社会功能相关的不良后果。与没有精神问题史的参与者相比，患有儿童疾病的参与者至少有一种不良成人结局的几率高出6倍，2种或2种以上此类指标的几率高出9倍（1个指标：59.5% vs. 19.9%，p <0.001; 2+指标：34.2% vs. 5.6%，p <0.001）。在统计学上控制了儿童心理社会困难和成人精神问题后，这些关联仍然存在。风险并不局限于那些有诊断的人：有阈下精神问题的参与者发生成人不良结局的几率高3倍，发生2种或2种以上结局的几率高5倍（1个指标：41.9% vs. 19.9%，p <0.001; 2+指标：23.2% vs. 5.6%，p <0.001）。不良结局的最佳诊断预测因子是儿童期精神疾病的累积暴露。常见的，通常是中度损害的，儿童期精神病问题与向成年期的过渡中断有关，即使这些问题不会持续到成年期，即使这些问题是阈下的。这些问题为公共卫生工作提供了潜在的目标，以减轻成人的痛苦和发病率。
Psychiatric problems are among the most common health problems of childhood. To test whether these health problems adversely affect adult functioning even if the problems themselves do not persist. Prospective, population-based study of 1420 participants assessed with structured interviews up to 6 times in childhood (ages 9 to 16; 6674 observations) for common psychiatric diagnoses and subthreshold psychiatric problems. Community sample. Participants were then assessed 3 times in young adulthood (ages 19, 21, and 24–26; 3215 observations of 1273 subjects) for adverse outcomes related to health, legal, financial, and social functioning. Participants with a childhood disorder had 6 times higher odds of at least one adverse adult outcome as compared to those with no history of psychiatric problems and 9 times higher odds of 2 or more such indicators (1 indicator: 59.5% vs. 19.9%, p <0.001; 2+ indicators: 34.2% vs. 5.6%, p <0.001). These associations persisted after statistically controlling for childhood psychosocial hardships and adult psychiatric problems. Risk was not limited to those with a diagnosis: participants with subthreshold psychiatric problems had 3 times higher odds of adult adverse outcomes and 5 time higher odds of 2 or more outcomes (1 indicator: 41.9% vs. 19.9%, p <0.001; 2+ indicators: 23.2% vs. 5.6%, p <0.001). The best diagnostic predictor of adverse outcomes was cumulative childhood exposure to psychiatric disorders. Common, typically moderately-impairing, childhood psychiatric problems are associated with a disrupted transition to adulthood even if the problems do not persist into adulthood and even if the problems are subthreshold. Such problems provide potential target for public health efforts to ameliorate adult suffering and morbidity.