Lifetime co-morbidity of DSM-IV disorders in the US National Comorbidity Survey Replication Adolescent Supplement (NCS-A).
Lifetime co-morbidity of DSM-IV disorders in the US National Comorbidity Survey Replication Adolescent Supplement (NCS-A).
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DOI：
10.1017/s0033291712000025
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发表时间：
2012-09
影响因子：
6.9
通讯作者：
Merikangas, K. Ries
中科院分区：
文献类型：
--
作者：
Kessler, R. C.;Avenevoli, S.;McLaughlin, K. A.;Green, J. Greif;Lakoma, M. D.;Petukhova, M.;Pine, D. S.;Sampson, N. A.;Zaslavsky, A. M.;Merikangas, K. Ries
对常见精神障碍共病结构的研究主要集中在当前的患病率，而不是共病的发展。本报告介绍了根据科摩罗全国青少年重复调查补充资料（NCS-A）进行的后一种分析的初步结果。对青少年精神障碍进行了一次全国性调查。DSM-IV诊断基于对青少年进行的复合国际诊断访谈和对父母进行的自我问卷调查。因子分析检查15个终生DSM-IV疾病的共患病率。离散时间生存分析被用来预测首次发病的每一种疾病的信息有关的先前历史的其他14种疾病。因子分析发现四个因素代表恐惧，痛苦，行为和物质障碍。时间原发性疾病与随后发生的其他疾病（使用回顾性发病年龄报告）的关联几乎完全是积极的。类内关联（例如，抑郁障碍预测随后发生的其他抑郁障碍）比类间关联（33.0%）更具有一致性显著性（63.2%）。随着疾病间共病率的增加，关联强度下降。对于早发性疾病（特定恐惧症和注意力缺陷/多动障碍），由时间既往疾病解释的终生疾病百分比（在预测而非因果意义上）在3.7-6.9%之间，而对于迟发性疾病，这一百分比要高得多（23.1-64.3%）。恐惧障碍是大多数其他后续疾病的最强预测因子。青少年精神障碍是高度共病的。时间原发性恐惧障碍与许多其他迟发性疾病的强相关性表明，恐惧障碍可能是早期干预的有希望的目标。
Research on the structure of comorbidity among common mental disorders has largely focused on current prevalence rather than on the development of comorbidity. This report presents preliminary results of the latter type of analysis based on the National Comorbidity Survey Replication Adolescent Supplement (NCS-A). A national survey was carried out of adolescent mental disorders. DSM-IV diagnoses were based on the Composite International Diagnostic Interview administered to adolescents and questionnaires self-administered to parents. Factor analysis examined comorbidity among 15 lifetime DSM-IV disorders. Discrete-time survival analysis was used to predict first onset of each disorder from information about prior history of the other 14 disorders. Factor analysis found four factors representing fear, distress, behavior, and substance disorders. Associations of temporally primary disorders with the subsequent onset of other disorders (dated using retrospective age-of-onset reports) were almost entirely positive. Within-class associations (e.g., distress disorders predicting subsequent onset of other distress disorders) were more consistently significant (63.2%) than between-class associations (33.0%). Strength of associations decreased as comorbidity among disorders increased. The percent of lifetime disorders explained (in a predictive rather than causal sense) by temporally prior disorders was in the range 3.7-6.9% for earliest-onset disorders (specific phobia and attention-deficit/hyperactivity disorder) and much higher (23.1-64.3%) for later-onset disorders. Fear disorders were the strongest predictors of most other subsequent disorders. Adolescent mental disorders are highly comorbid. The strong associations of temporally primary fear disorders with many other later-onset disorders suggest that fear disorders might be promising targets for early interventions.