Structural models of the comorbidity of internalizing disorders and substance use disorders in a longitudinal birth cohort
Structural models of the comorbidity of internalizing disorders and substance use disorders in a longitudinal birth cohort
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DOI：
10.1007/s00127-010-0268-1
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发表时间：
2011-10-01
影响因子：
4.4
通讯作者：
Horwood, L. John
中科院分区：
文献类型：
--
作者：
Fergusson, David M.;Boden, Joseph M.;Horwood, L. John
本研究使用结构方程模型检验内化障碍和物质使用障碍之间的关联，以检验常见固定混杂因素和直接因果通路的相对贡献，并确定因果关系的方向。数据是在基督城健康与发展研究过程中收集的，对新西兰儿童（n = 953）的出生队列进行的25年纵向研究。测量包括18岁、21岁和25岁的重度抑郁症、焦虑症、酒精滥用/依赖、尼古丁依赖和非法药物滥用/依赖的DSM-IV症状标准。结构方程模型显示，对于抑郁症和物质使用障碍，最好的-拟合模型是一种通过共同的固定因素和从物质使用到萧条焦虑症和（1）尼古丁依赖和（2）非法药物滥用/依赖也出现了类似的模式。焦虑症和酒精滥用/依赖的共病最好的解释模型，包括共同的固定因素和这些疾病之间的相互作用途径。对内化障碍与物质使用障碍的相关性进行分解发现，内化障碍与物质使用障碍之间的相关性主要来自于两种障碍之间的直接因果通路，提示内化障碍与物质使用障碍之间的共病既可以归因于共同的固定因素，也可以归因于两种障碍之间的直接因果通路。证据表明，在大多数情况下，对因果关系最合理的解释是物质使用障碍增加了内化障碍的风险。
The present study examined the associations between internalizing disorders and substance use disorders using structural equation models to examine the relative contributions of common fixed confounding factors and direct causal pathways, and to determine the direction of causality.Data were gathered during the course of the Christchurch Health and Development Study, a 25-year longitudinal study of a birth cohort of New Zealand children (n = 953). Measures included DSM-IV symptom criteria for major depression, anxiety disorders, alcohol abuse/dependence, nicotine dependence, and illicit drug abuse/dependence, ages 18, 21, and 25.Structural equation modeling showed that for depression and substance use disorder, the best-fitting model was the one in which the associations were explained by a combination of common fixed factors and direct causal pathways from substance use to depression. A similar pattern emerged for anxiety disorders and (1) nicotine dependence, and (2) illicit drug abuse/dependence. The comorbidity of anxiety disorder and alcohol abuse/dependence was best explained by a model that included common fixed factors and a reciprocal pathway between these disorders. Decomposition of the correlations between internalizing disorders and substance use disorders showed that most of the correlation arose from direct causal pathways between disorders.The findings suggest that the comorbidity between internalizing disorders and substance use disorders can be attributed to both common fixed factors and direct causal pathways between substance use disorder and internalizing disorder. The evidence suggests that, in most cases, the most plausible explanation of causality is the one in which substance use disorder increases the risk of internalizing disorder.