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

描述（由申请人提供）：预防性干预措施在很大程度上取决于有关精神病理学发展的可靠和具体信息的可用性。2007/2008年NIMH战略计划中确定的临床研究的三个优先领域是：1）预测有患病风险的个人; 2）个人生物，环境和社会因素的个性化知识，以更好地个性化干预措施;和3）临床研究中人和环境的多样性的参与匹兹堡女孩研究（PGS），一项大规模（n = 2，451）的代表性纵向研究，非裔美国人和欧洲裔美国女孩的城市样本，是唯一准备阐明这些主题领域的每一个，因为它们涉及到行为障碍（CD）和严重抑郁症（MDD）：两种疾病，产生最大量的发病率在青春期女性和贡献的最大部分全球疾病负担的妇女（默里和洛佩斯。1997年）。特别是，PGS旨在预测女性CD和MDD，通过建立风险和保护的发展模型，从早期识别作为儿童期疾病前兆的个体脆弱性，以及这种脆弱性更可能导致疾病的背景，通过操作疾病的亚综合征表型，并通过检查共病条件模式的发展变化。预测将基于对这个种族和经济多样化样本的多次年度评估，这些样本具有高参与者保留率（7波平均为94%）。到目前为止，我们已经生成了关于CD和MDD以及广泛的其他疾病的DSM-IV症状的发作、稳定性和发展过程的数据。我们还评估了潜在的调节和中介因素对发展的乳腺癌的女孩。我们正在寻求资金，以继续这项前瞻性研究，通过青春期的女孩和他们的母亲和父亲的五个年度评估。第一波的女孩年龄为13 - 16岁，第五波的女孩年龄为17 - 20岁。计划的评估与儿童期已收集的发育数据相关联时，将阐明青春期CD和MDD的前驱体、其亚综合征表型、共病的常见模式以及与前驱体、亚综合征、疾病和共病疾病转变相关的风险、促进和保护因素。该研究有助于了解CD和MDD表现的种族差异，并可作为构建模块，为CD、MDD、其共病风险以及与其他疾病共病的特定女孩亚组开发个性化、预防性和补救性治疗。公共卫生相关性：这项拟议的研究将提供有关年轻女孩的具体情绪和行为问题的信息，这些问题是青春期和成年早期严重问题的标志。该研究还研究了增加或减少这些风险的家庭，同龄人，学校和邻里因素。该社区样本中参与者的多样性（例如，非洲裔美国人和欧洲裔美国人女孩的数量相等，收入水平广泛）将允许收集有关早期和持续风险和问题的信息，这些信息对不同的亚组更为重要，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.