Zurich Cohort Study of Young Adults

苏黎世队列研究是一项前瞻性纵向研究，对瑞士苏黎世的一组年轻人进行了20-40岁的随访，以估计主要精神障碍的患病率、发病率、损害、治疗模式和稳定性。本研究评估了广泛的精神综合征以及躯体综合征，包括在常规诊断阈值下的轻度表现。 苏黎世队列研究由代表瑞士苏黎世州的4,547名受试者（m=2201; f = 2346）组成，这些受试者于1978年使用症状自评量表90-R进行筛查。为了丰富精神症状的可能性，591名受试者（291名男性，299名女性）的子样本被选中进行访谈，其中三分之二由高分者（定义为SCL-90的第85百分位数或以上）和得分低于第85百分位数的随机样本组成。总共有6波采访，覆盖20-40岁的年龄段。那些退出的人在人口统计学特征或研究进入时的风险组方面的基线测量没有显著差异。 一个直接的采访，结构化的精神病理学采访和流行病学的社会后果评级（SPIKE），由精神科住院医师和临床心理学家在受试者的家中进行了广泛的临床培训。该访谈计划评估了一些躯体综合征，包括头痛、胃肠道、心血管和呼吸综合征，以及心理综合征，包括抑郁、焦虑、恐惧、强迫症和药物滥用。而不是坚持一个单一的诊断分类系统，整个频谱的症状和相关性进行了评估。其他措施包括所有综合征的个人和家族史，损伤和痛苦的维度测量，人格特质和其他相关结构。 焦虑和抑郁共病往往比单独的综合征更持久。只有焦虑状态的个体倾向于在成年后发展为抑郁或焦虑和抑郁共病。相比之下，随着时间的推移，单独的抑郁症和与焦虑共病的抑郁症往往比单独的焦虑症稳定得多。这些发现对情感障碍的分类和治疗具有重要意义。共病焦虑和抑郁的稳定性比单独的疾病说明了进一步调查的重要性，共病状态相比，非共病状态的病因和治疗研究。从早期到中期，阈下水平抑郁和焦虑的持续存在表明，描述抑郁和焦虑表达的连续性而不是坚持严格的诊断阈值的重要性。

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. 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. 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.