Prediction of differential adult health burden by conduct problem subtypes in males
Prediction of differential adult health burden by conduct problem subtypes in males
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DOI：
10.1001/archpsyc.64.4.476
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发表时间：
2007-04-01
影响因子：
--
通讯作者：
Moffitt, Terrie E.
中科院分区：
文献类型：
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作者：
Odgers, Candice L.;Caspi, Avshalom;Moffitt, Terrie E.
内容：DSM-IV的品行障碍诊断标准的一个主要特征是区分儿童期和青少年期发作的亚型。这些发展亚型是否存在于人群中，是否有不同的行为问题，应该进行严格的测试，以告知DSM-V。目的：在一个前瞻性的出生队列中评估儿童期与青少年期发作的行为问题的流行病学有效性，并评估终身持续的行为问题是否与更大的成人健康负担相关。设计、设置和参与者：我们的样本包括达尼丁多学科健康与发展研究中的526名男性研究成员，这是一项1年出生队列研究（1972年4月1日至1973年3月30日）。发展轨迹的定义使用前瞻性评级的行为问题，在7，9，11，13，15，18，21，和26岁。主要结果measurements：健康负担进行了评估，作为精神和身体健康问题，在32岁通过诊断访谈和体检测量。通过一般生长混合模型，Weidentified以下4个发展亚型的行为问题：（1）儿童期发病/生活过程-持续，（2）青少年期发病，（3）儿童期有限，（4）低。在32岁时，具有生命过程持续亚型的研究成员经历了最严重的健康负担。在较小程度上，那些青少年发病亚型也经历了健康问题。一个儿童期有限的亚型没有指定的DSM-IV被发现，其成人健康结果的范围内的队列norm.Conclusions：结果支持的流行病学有效性的DSM-IV的行为障碍的区别发病年龄的基础上，但强调还需要考虑长期的持久性，以完善诊断。预防和治疗行为问题有可能减轻成人的健康负担。
Context: A cardinal feature of the DSM-IV diagnostic criteria for conduct disorder is the distinction between childhood- vs adolescent- onset subtypes. Whether such developmental subtypes exist in the population and have different prognoses should be rigorously tested to inform the DSM-V.Objectives: To evaluate the epidemiological validity of childhood- vs adolescent- onset conduct problems in a prospective birth cohort, and to assess whether life-course-persistent conduct problems are associated with a greater adult health burden.Design, Setting, and Participants: Our sample includes 526 male study members in the Dunedin Multidisciplinary Health and Development Study, a 1-year birth cohort( April1, 1972, through March 30, 1973). Developmental trajectories were defined using prospective ratings of conduct problems at 7, 9, 11, 13, 15, 18, 21, and 26 years of age.Main Outcome Measures: Health burden was assessed as mental and physical health problems at 32 years of age measured via diagnostic interviews and physical examinations.Results: Weidentified the following 4 developmental subtypes of conduct problems through general growth mixture modeling:(1) childhood-onset/life-course-persistent,(2) adolescent onset, (3) childhoodlimited, and( 4) low. At32years of age, study members with the life-course-persistent subtype experienced the worst health burden. To a lesser extent, those with the adolescent- onset subtype also experienced health problems. A childhood- limited subtype not specified by DSM-IV was revealed; its adult health outcomes were within the range of the cohort norm.Conclusions: Results support the epidemiological validity of the DSM-IV conduct disorder distinction based on age of onset but highlight the need to also consider long-term persistence to refine diagnosis. Preventing and treating conduct problems has the potential to reduce the adult health burden.