Mental health resilience in the adolescent offspring of parents with depression: a prospective longitudinal study.
Mental health resilience in the adolescent offspring of parents with depression: a prospective longitudinal study.
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DOI：
10.1016/s2215-0366(15)00358-2
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发表时间：
2016-01
期刊：
影响因子：
--
通讯作者：
Thapar A
中科院分区：
文献类型：
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作者：
Collishaw S;Hammerton G;Mahedy L;Sellers R;Owen MJ;Craddock N;Thapar AK;Harold GT;Rice F;Thapar A
父母患有抑郁症的年轻人患精神疾病的风险大大增加，但结果不佳并非不可避免。确定高家庭风险年轻人心理健康复原力的贡献者是国际公认的优先事项。我们的目标是确定保护性因素，预测持续良好的心理健康的青少年与抑郁症的父母，并测试这些是否有助于超出父母的疾病严重程度所解释的。青少年抑郁症早期预测研究（EPAD）是一项针对父母患有复发性抑郁症的后代的前瞻性纵向研究。在社区环境中，对患有复发性重度抑郁症的父母、共同父母和子女（基线时年龄为9-17岁）进行了4年3次评估。后代的结果是可操作的精神健康障碍，阈下症状，或自杀的情况下，所有三个研究场合（持续良好的心理健康）;和优于预期的心理健康（情绪和行为症状在后续低于预测的父母抑郁症的严重程度）。家庭，社会，认知和健康行为预测变量进行了评估，采用访谈和问卷调查的措施。在2007年2月至6月期间，我们在基线时筛选了337个家庭，其中331个符合条件。其中，262人完成了三项评估，并被纳入持续心理健康数据。青少年心理健康问题很常见，但262名青少年中有53名（20%）表现出持续良好的心理健康状况。指数父母积极表达情绪（比值比1.91 [95% CI 1.31 - 2.79]; p= 0.001），共同父母支持（1·90 [1·38-2·62]; p<0·0001），良好的社会关系（2.07 [1.35 - 3.18]; p= 0.001）、自我效能（1.49 [1.05 - 2.11]; p= 0.03）和经常锻炼（2.96 [1.26 - 6.92]; p= 0.01）与持续良好的心理健康相关。对父母抑郁严重程度的分析是一致的，但频繁锻炼只能预测好于预期的情绪相关心理健康（β=-0统计22; p= 0.0004）而不是行为心理健康，而指数父母的积极情绪表达预测好于预期的行为心理健康（β=-0统计16; p= 0.01）而不是情绪相关心理健康。后代没有心理健康问题需要多种保护因素（零或一个保护因素，4%保持良好的心理健康;两个保护因素，10%;三个保护因素，13%，四个保护因素，38%;五个保护因素，48%）。青少年心理健康问题是常见的，但不是不可避免的，即使父母抑郁症是严重的和经常性的。这些研究结果表明，预防方案将需要在不同的功能领域加强多种保护因素。经济和社会研究理事会朱尔斯·索恩爵士慈善信托基金。
Young people whose parents have depression have a greatly increased risk of developing a psychiatric disorder, but poor outcomes are not inevitable. Identification of the contributors to mental health resilience in young people at high familial risk is an internationally recognised priority. Our objectives were to identify protective factors that predict sustained good mental health in adolescents with a parent with depression and to test whether these contribute beyond what is explained by parent illness severity. The Early Prediction of Adolescent Depression study (EPAD) is a prospective longitudinal study of offspring of parents with recurrent depression. Parents with recurrent major depressive disorder, co-parents, and offspring (aged 9–17 years at baseline) were assessed three times over 4 years in a community setting. Offspring outcomes were operationalised as absence of mental health disorder, subthreshold symptoms, or suicidality on all three study occasions (sustained good mental health); and better than expected mental health (mood and behavioural symptoms at follow-up lower than predicted given severity of parental depression). Family, social, cognitive, and health behaviour predictor variables were assessed using interview and questionnaire measures. Between February and June, 2007, we screened 337 families at baseline, of which 331 were eligible. Of these, 262 completed the three assessments and were included in the data for sustained mental health. Adolescent mental health problems were common, but 53 (20%) of the 262 adolescents showed sustained good mental health. Index parent positive expressed emotion (odds ratio 1·91 [95% CI 1·31–2·79]; p=0·001), co-parent support (1·90 [1·38–2·62]; p<0·0001), good-quality social relationships (2·07 [1·35–3·18]; p=0·001), self-efficacy (1·49 [1·05–2·11]; p=0·03), and frequent exercise (2·96 [1·26–6·92]; p=0·01) were associated with sustained good mental health. Analyses accounting for parent depression severity were consistent, but frequent exercise only predicted better than expected mood-related mental health (β=–0·22; p=0·0004) not behavioural mental health, whereas index parents' expression of positive emotions predicted better than expected behavioural mental health (β=–0·16; p=0·01) not mood-related mental health. Multiple protective factors were required for offspring to be free of mental health problems (zero or one protective factor, 4% sustained good mental health; two protective factors, 10%; three protective factors, 13%, four protective factors, 38%; five protective factors, 48%). Adolescent mental health problems are common, but not inevitable, even when parental depression is severe and recurrent. These findings suggest that prevention programmes will need to enhance multiple protective factors across different domains of functioning. Sir Jules Thorn Charitable Trust, Economic and Social Research Council.