Latent Trajectories of Common Mental Health Disorder Risk Across 3 Decades of Adulthood in a Population-Based Cohort
Latent Trajectories of Common Mental Health Disorder Risk Across 3 Decades of Adulthood in a Population-Based Cohort
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DOI：
10.1001/jamapsychiatry.2016.1921
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发表时间：
2016-10-01
期刊：
影响因子：
25.8
通讯作者：
Merikangas, Kathleen R.
中科院分区：
文献类型：
--
作者：
Paksarian, Diana;Cui, Lihong;Merikangas, Kathleen R.
重要性：流行病学证据表明，大多数普通人群在其生命中的某个阶段会经历精神健康障碍。然而，很少有前瞻性的基于人群的研究估计了从青年到中年精神障碍的风险轨迹，以估计在这个年龄段经历持续精神障碍的个体的比例。目的描述在整个成年期经历持续性精神障碍的人群比例，并估计该年龄段潜在的精神障碍风险轨迹。设计、环境和参与者一项基于人群的前瞻性队列研究于1979年至2008年在瑞士苏黎世州进行。1978年，591名年龄分别为19岁（男性）和20岁（女性）的瑞士公民被纳入分层随机样本；在29年的时间里进行了7次访谈。男性从军队登记记录中取样，女性从选举记录中取样。从最初登记的参与者中，有高度精神症状的参与者被抽样进行随访。数据分析时间为2015年7月28日至2016年6月8日。使用生长混合模型估计过去一年的情绪/焦虑障碍（即重度抑郁发作、恐惧、恐慌、广泛性焦虑障碍和强迫症）、物质使用障碍（即药物滥用或依赖、酒精滥用或依赖）和任何精神障碍（即上述任何一种）的潜在轨迹，在每一波的面对面半结构化访谈中评估。诊断依据DSM-III、DSM-III- r和DSM-IV标准。结果基线时591名参与者中，299名（50.6%）为女性。跨越多个研究波的持续性精神健康障碍是罕见的。252人（42.6%）参加了所有7个研究波，每次只有1.2%符合障碍标准。生长混合模型确定了成年期任何疾病的3类风险：低（估计患病率，40.0%;95% CI, -8.7%至88.9%）、增加-减少（估计患病率，15.3%;95% CI， 1.0%至29.6%）和增加（估计患病率，44.7%;95% CI, -0.9%至90.1%）。虽然没有一个班级的障碍风险持续高，但对于那些在增加-减少班级的人来说，从20多岁到40多岁的风险是高的。按性别划分的模型显示，女性有4个轨迹类别，而男性只有3个。结论和相关性在这个以人群为基础的样本中，30年的成年期持续的高精神健康障碍风险是罕见的。确定性别风险轨迹的早期决定因素将有利于预防工作。
IMPORTANCE Epidemiologic evidence indicates that most of the general population will experience a mental health disorder at some point in their lives. However, few prospective population-based studies have estimated trajectories of risk for mental disorders from young through middle adulthood to estimate the proportion of individuals who experience persistent mental disorder across this age period.OBJECTIVES To describe the proportion of the population who experience persistent mental disorder across adulthood and to estimate latent trajectories of disorder risk across this age period.DESIGN, SETTING, AND PARTICIPANTS A population-based, prospective cohort study was conducted between 1979 and 2008 in the canton of Zurich, Switzerland. A stratified random sample of 591 Swiss citizens was enrolled in 1978 at ages 19 years (men) and 20 years (women); 7 interviews were performed during a 29-year period. Men were sampled from military enrollment records and women from electoral records. From those initially enrolled, participants with high levels of psychiatric symptoms were oversampled for follow-up. Data analysis was performed from July 28, 2015, to June 8, 2016.MAIN OUTCOMES AND MEASURES Latent trajectories, estimated using growth mixture modeling, of past-year mood/anxiety disorder (ie, major depressive episode, phobias, panic, generalized anxiety disorder, and obsessive-compulsive disorder), substance use disorder (ie, drug abuse or dependence and alcohol abuse or dependence), and any mental disorder (ie, any of the above) assessed during in-person semistructured interviews at each wave. Diagnoses were based on DSM-III, DSM-III-R, and DSM-IV criteria.RESULTS Of the 591 participants at baseline, 299 (50.6%) were female. Persistent mental health disorder across multiple study waves was rare. Among 252 individuals (42.6%) who participated in all 7 study waves, only 1.2% met criteria for disorder every time. Growth mixture modeling identified 3 classes of risk for any disorder across adulthood: low (estimated prevalence, 40.0%; 95% CI, -8.7% to 88.9%), increasing-decreasing (estimated prevalence, 15.3%; 95% CI, 1.0% to 29.6%), and increasing (estimated prevalence, 44.7%; 95% CI, -0.9% to 90.1%). Although no classes were characterized by persistently high disorder risk, for those in the increasing-decreasing class, risk was high from the late 20s to early 40s. Sex-specific models indicated 4 trajectory classes for women but only 3 for men.CONCLUSIONS AND RELEVANCE Persistently high mental health disorder risk across 3 decades of adulthood was rare in this population-based sample. Identifying early determinants of sex-specific risk trajectories would benefit prevention efforts.