Pathways to Psychiatric & Medical Comorbidity in Adults

描述(由申请人提供)：最近的研究表明，暴露在围产期问题和社会逆境中，加上母亲的抑郁，至少在一定程度上解释了子女在婴儿期、儿童期和成年期出现行为、情感和医疗问题的风险增加。患有抑郁症等精神疾病的人，如果有共同的医疗问题，功能障碍会增加，更频繁地使用医疗保健服务，自杀意念的发生率也更高。通过检查生命周期(出生、婴儿期、儿童期和成年期)的问题，阐明这一现象发生的机制，将有助于澄清选定的精神疾病(抑郁症和药物使用)和选定的共病疾病(过敏、头痛和心脏病)的时间顺序。这项研究利用了一个无与伦比的机会，利用了一项基于社区的纵向研究(N=1758)的数据集，该研究对父母及其子女进行了30多年的跟踪调查，拟议的研究有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)以及成年后精神和医学疾病的直接和间接影响；2)阐明从社会逆境和围产期风险到成人精神和医学疾病的路径，通过婴儿期和儿童期的不同问题；3)检查从儿童到成年的精神和医学疾病的时间顺序；4)比较同时患有精神疾病和合并疾病的人、患有一种疾病的人和没有患有精神疾病的人的社会和功能损害水平，如自杀意念、医院利用和个人资源；5)检查母亲抑郁和家庭支持作为调节因素的作用。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来分析数据来实现。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，以便计划更具成本效益和时间效益的早期干预。

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.