Pathways to Psychiatric & Medical Comorbidity in Adults

描述（由申请人提供）：最近的研究表明，暴露于围产期问题和社会逆境与母亲抑郁相结合，至少部分地解释了后代在婴儿期、儿童期和成年期出现行为、情感和医疗问题的风险增加。患有精神疾病（如抑郁症）的人，如果同时存在医疗问题，则会增加功能损害，更频繁地使用卫生保健服务，并且更容易产生自杀念头。通过检查整个生命周期（出生、婴儿期、儿童期和成年期）的问题，阐明这种现象发生的机制，将有助于阐明选定的精神疾病（抑郁症和药物使用）和选定的共病医学疾病（过敏、头痛和心脏病）的时间序列。利用前所未有的机会，利用基于社区的纵向研究（N=1758）的数据集，跟踪父母及其后代超过30年，本研究提出了5个目标：1)调查围产期风险对婴儿期和儿童期不同问题（情绪/行为，医学和神经学）以及成年期精神和医学疾病的直接和间接影响；2)阐明社会逆境和围产期风险通过婴儿期和儿童期不同问题介导成人精神和医学疾病的途径；3)检查从童年到成年的精神疾病和医学疾病的时间顺序；4)比较有精神疾病和共病者、有精神疾病和无精神疾病者的社会和功能障碍水平，如自杀意念、医院使用和个人资源；5)考察母亲抑郁和家庭支持的调节作用。这些目标将通过使用结构方程模型、对数线性模型和比例风险模型等严格的统计技术分析数据来实现。该项目的研究结果将为临床医生和政策制定者提供重要信息，以便制定更具成本效益和时效性的早期干预措施。

DESCRIPTION (provided by applicant): Recent studies suggest that an exposure to perinatal problems and social adversity in conjunction with maternal depression explain, at least in part, the increased risk of behavioral, emotional, and medical problems in offspring in their infancy, childhood, and adulthood. Individuals with psychiatric illness such as depression who have a comorbid medical problem have increased functional impairment, more frequent use of health care services, and a higher prevalence of suicidal ideation. Elucidation of the mechanism through which the phenomenon occurs, through examination of problems across the life cycle (birth, infancy, childhood, and adulthood), will help clarify the temporal sequences of the selected psychiatric illness (depression and substance use) and selected comorbid medical illness (allergies, headaches, and heart disease). Exploiting an unparalleled opportunity to utilize the dataset from a community-based longitudinal study (N=1758) that followed parents and their offspring for over 30 years, the proposed study has 5 aims: 1) to investigate direct and indirect (through social adversity) effects of perinatal risk on different problems (emotional/behavioral, medical, and neurological) in infancy and childhood, as well as psychiatric and medical illness in adulthood; 2) to elucidate pathways from social adversity and perinatal risk to adult psychiatric and medical illness, mediated through different problems in infancy and childhood; 3) to examine the temporal sequence of psychiatric and medical illness from childhood to adulthood; 4) to compare the level of social and functional impairment, such as suicidal ideation, hospital use, and personal resources among those with both psychiatric and comorbid medical illness, those with one and those with neither illness; 5) to examine the role of maternal depression and family support as moderators. These aims will be implemented by analyzing the data using rigorous statistic techniques such as structural equation model, log linear model, and proportional hazards model. The findings of this project will provide important information for both clinicians and policy makers in order to plan more cost-effective and time-effective early intervention.