Conduct Disorder & Depression in Girls: Precursors, Development and Comorbidity

说明(申请人提供)：预防干预在很大程度上取决于是否有关于精神病理学发展的可靠和具体的信息。在2007/2008 NIMH战略计划中确定的临床研究的三个优先领域是：1)预测个人罹患疾病的风险；2)个性化关于个人生物、环境和社会因素的知识，以更好地个性化干预措施；匹兹堡女孩研究(PGS)是一项大规模(n=2,451)的纵向研究，对非洲裔美国人和欧洲裔美国女孩的代表性城市样本进行了纵向研究，独特地阐明了这些主题领域中的每一个，因为它们与品行障碍(CD)和严重抑郁障碍(MDD)有关：这两种疾病在青春期女性中造成最大的发病率，并在全球女性疾病负担中占最大比例(Murray和Lopez)。1997年)。特别是，PGS旨在通过建立风险和保护的发展模型来预测女性CD和MDD，从早期识别作为儿童疾病前驱的个体脆弱性，以及这种脆弱性更有可能导致障碍的背景，通过实施障碍的亚综合征表型，并通过检查共病情况模式的发育变化。预测将基于对这一种族和经济多元化样本的多个年度评估，参与者保留率很高(7波平均为94%)。到目前为止，我们已经生成了CD和MDD以及广泛的其他疾病的DSM-IV症状的开始、稳定和发展过程的数据。我们还评估了影响女孩症状发展的潜在调节和调节因素。我们正在寻求资金，在整个青春期继续这项前瞻性研究，对女孩及其父母进行五次年度评估。这些女孩在第一波中的年龄为13-16岁，在第五波中的年龄为17-20岁。计划中的评估与童年时期已经收集的发育数据相联系，将阐明青春期CD和MDD的前体、它们的亚综合征表型、常见的共病模式，以及与先兆、亚综合征、障碍和共病障碍过渡相关的风险、促进和保护因素。这项研究与了解CD和MDD表现的种族差异有关，并可作为为有CD、MDD风险的特定女孩亚群制定个性化、预防性和补救性治疗的基础，这两种疾病的共同出现以及与其他疾病的共病。公共卫生相关性：这项拟议的研究将提供关于年轻女孩特定情绪和行为问题的信息，这些问题是青春期和青春期以后严重问题的标志。这项研究还考察了增加或降低这些风险的家庭、同龄人、学校和邻居因素。该社区样本参与者的多样性(例如，同等数量的非裔美国人和欧洲裔美国女孩，收入水平范围广泛)将使人们能够收集关于对不同亚群更重要的早期和持续风险和问题的信息，这些信息可以作为筛查设备和预防青少年情绪和行为问题的基础。

DESCRIPTION (provided by applicant): Preventive interventions depend in large part on the availability of reliable and specific information about the development of psychopathology. Three of the priority areas for clinical research identified in the 2007/2008 NIMH Strategic Plan are the 1) prediction of individuals at risk for developing disease; 2) personalization of knowledge about individual biological, environmental and social factors to better personalize interventions; and 3) participation of the diversity of people and settings in clinical research The Pittsburgh Girls Study (PGS), a large-scale (n=2,451), longitudinal study of a representative, urban sample of African American and European American girls, is uniquely poised to illuminate each of these topic areas as they pertain to Conduct Disorder (CD) and Major Depressive Disorder (MDD): two disorders that generate the greatest amount of morbidity among adolescent females and contribute the largest portion to the global burden of disease among women (Murray & Lopez. 1997). In particular, the PGS aims to predict female CD and MDD by building developmental models of risk and protection from the early identification of individual vulnerabilities that serve as childhood precursors to disorders, and the contexts in which such vulnerabilities are more likely to lead to disorder, by operationalizing sub-syndromal phenotypes of disorders, and by examining developmental changes in the pattern of comorbid conditions. Prediction will be based on multiple annual assessments of this racially and economically diverse sample with high rates of participant retention (average of 94 percent over 7 waves). Thus far, we have generated data on the onset, stability and developmental course of DSM-IV symptoms for CD and MDD and a broad range of other disorders. We also have assessed potential moderating and mediating factors on the development of symptomatology in girls. We are seeking funds to continue this prospective study through adolescence with five annual assessments of the girls and their mothers and fathers. The girls will be aged 13-16 in wave 1, and aged 17-20 years in wave 5. The planned assessments, when linked to the developmental data already collected during childhood, will elucidate precursors to CD and MDD in adolescence, their sub-syndromal phenotypes, common patterns of comorbidity, and risk, promotive and protective factors associated with transitions from precursor, to sub-syndrome, to disorder, and to comorbid disorders. The study is relevant for understanding ethnic disparities in the manifestation of CD and MDD and can serve as a building block for personalized, preventive and remedial treatments to be developed for specific subgroups of girls at risk of CD, MDD, their co-occurrence, and comorbidity with other disorders. PUBLIC HEALTH RELEVANCE: The proposed study will provide information on specific emotional and behavioral problems assessed in young girls that are markers for later serious problems in adolescence and young adulthood. The study also examines family, peer, school, and neighborhood factors that increase or reduce these risks. The diversity of the participants in this community sample (e.g. equal numbers of African American and European American girls, broad range of income levels) will allow information to be gathered about early and ongoing risks and problems that are more important for different subgroups, which can serve as building blocks for screening devices and the prevention of adolescent emotional and behavioral problems.