Zurich Cohort Study of Young Adults

苏黎世队列研究是对瑞士苏黎世一群20-40岁的年轻人进行的前瞻性纵向研究，目的是评估主要精神障碍的患病率、发病率、损害、治疗模式和稳定性。这项研究评估了广泛的精神症状和躯体症状，包括在传统诊断阈值下的轻微表现(Anst等人，1984)。 苏黎世队列研究由代表瑞士苏黎世的4547名受试者(m=2201；f=2346)组成，他们于1978年用症状检查表90-R(DeRogatis 1988)进行了筛查。为了丰富精神症状的发生概率，本研究选取了591名受试者(男291人，女299人)进行访谈，其中三分之二为高分者(以SCL-90的第85百分位数或以上为界)，并随机抽取得分低于第85百分位数的人作为样本。总共有6波采访涵盖了20-40岁的年龄段。那些退出的人在人口统计特征或研究开始时的风险组方面的基线测量没有显著差异。 由精神科住院医师和在受试者家中接受过广泛临床培训的临床心理学家进行直接访谈，即结构化精神病理学访谈和流行病学社会后果评级(SPAKE)。该面谈计划评估了一些躯体症状，包括头痛、胃肠道、心血管和呼吸综合征，以及心理症状，包括抑郁、焦虑、恐怖、强迫症和药物滥用。而不是坚持单一的诊断分类系统，而是评估了整个症状和相关谱系。其他测量包括所有症状的个人和家庭病史、损害和痛苦的维度测量、人格特征和其他相关结构。 同时存在的焦虑和抑郁往往比单独出现的任何一种症状都要持久得多。单独有焦虑状态的人在成年后往往要么单独患上抑郁症，要么同时患上焦虑和抑郁。相反，随着时间的推移，单独的抑郁和与焦虑共存的抑郁往往比单独的焦虑更稳定。这些发现对情感障碍的分类和治疗具有重要的意义。与任何一种疾病相比，焦虑和抑郁共病的稳定性更大，这说明了在病因学和治疗研究中，与非共病状态相比，进一步研究共病状态的重要性。亚阈值水平的抑郁和焦虑从成年早期到中期的持续存在表明，表征抑郁和焦虑的连续表达的重要性，而不是坚持严格的诊断阈值。 这项研究是首席研究员和瑞士苏黎世的朱尔斯·安斯特教授之间的持续合作。我们这个部门的资源一直致力于开发精神障碍演变的纵向数据的统计模型。我们开发了新的方法来研究焦虑和抑郁的纵向对称性，经过20年的随访，以及双相情感障碍和社交恐惧症在促进酒精使用向酒精依赖转变方面的作用。这些文件将在接下来的几个月内完成。然后，我们将重点研究偏头痛症状的演变及其与焦虑、情绪症状和成年期中期障碍的关联。

The Zurich Cohort Study is a prospective longitudinal study of a cohort of young adults from Zurich, Switzerland, who were followed from the ages of 20-40 in order to estimate the prevalence, incidence, impairment, treatment patterns and stability of the major mental disorders. This study assessed a wide range of psychiatric syndromes as well as somatic syndromes including mild manifestations under the conventional diagnostic thresholds (Angst et al 1984). The Zurich cohort study is comprised of a cohort of 4,547 subjects (m=2201; f = 2346) representative of the canton of Zurich in Switzerland, who were screened in 1978 with the Symptom Checklist 90-R (Derogatis 1988). In order to enrich the probability of psychiatric syndromes, a sub-sample of 591 subjects (291 males, 299 females) was selected for interview, with two thirds consisting of high scorers (defined by the 85th percentile or more of the SCL-90) and a random sample of those with scores below the 85th percentile. There have been a total of 6 waves of interviews covering the age period of 20-40 years. Those who had dropped out did not differ significantly in their baseline measures in terms of demographic characteristics, or risk group at study entry. A direct interview, the Structured Psychopathological Interview and Rating of the Social Consequences for Epidemiology (SPIKE), was administered by psychiatric residents and clinical psychologists with extensive clinical training in the subjects' homes. This interview schedule assesses a number of somatic syndromes, including headache, gastrointestinal, cardiovascular, and respiratory syndromes, as well as psychological syndromes, including depression, anxiety, phobia, obsessive-compulsive disorder, and substance abuse. Rather than adhering to a single diagnostic classification system, the entire spectrum of symptoms and correlates were assessed. Other measures included a personal and family history of all syndromes, dimensional measures of impairment and distress, personality traits, and other relevant constructs. Comorbid anxiety and depression tended to be far more persistent than either syndrome alone. Individuals with anxiety states alone tended to develop either depression alone or comorbid anxiety and depression as they progressed through adulthood. In contrast, depression alone and that which was comorbid with anxiety tended to be far more stable than anxiety alone over time.These findings have important implications for classification and treatment of affective disorders. The greater stability of comorbid anxiety and depression than either disorder alone illustrates the importance of further investigation of comorbid states compared to non-comorbid states in etiologic and treatment research. The persistence of subthreshold level depression and anxiety from early- to mid- adulthood suggests the importance of characterizing the continuum of expression of depression and anxiety rather than adhering to strict diagnostic thresholds. This study is an ongoing collaboration between the Principal Investigator and Professor Jules Angst in Zurich, Switzerland. The resources of our section have been devoted to the development of statistical models for longitudinal data on the evolution of mental disorders. We have developed new approaches to investigate the longitudinal symmetry of anxiety and depression across 20 years of follow-up, and the role of bipolar disorder and social phobia in facilitating transitions of alcohol use to alcohol dependence. These papers will be completed during the next several months. We will then focus on the evolution of migraine symptoms and their association with anxiety and mood symptoms and disorders across early to mid adulthood.