National Comorbidity Survey - Replication (NCS-R)

在过去的一年里，我们研究了在成人（NCS-R）和青少年（NCS-A）中观察到的抑郁结构，发现成人和青少年之间的类别和概率非常相似，成年人的结构比青少年更复杂。在这些分析中确定的亚型表明，抑郁症状的症状模式和严重程度是重性抑郁症异质性的来源。我们还研究了母亲和父亲的精神病理与忽视亚型之间的关联，评估了忽视亚型与成人终身DSM-IV障碍之间的关联，并在调整了父母的精神病理、其他不良经历、回忆偏差以及社会和人口统计学相关因素后，评估了忽视与精神病理之间的独立关联。我们发现儿童监督忽视与暴露青少年的负面心理健康结果相关，独立于其他人口统计学和家庭风险因素。此外，父亲和母亲的精神病理都显示出与忽视亚型的显著关联。这些发现强调了忽视在描述童年逆境中的重要性，并证明了更广泛地概念化童年风险因素对成人精神病理学的重要性（Heaton等人，正在审查中）。

During the past year, we have investigated the structure of depression observed in adults (NCS-R) and adolescents (NCS-A) and found highly similar classes and probabilities across adults and youth, with greater complexity in structure among adults than in adolescents. The subtypes identified in these analyses suggest that both symptom patterns and severity of depressive symptoms are sources of heterogeneity in major depressive disorder. We have also examined the associations between both maternal and paternal psychopathology and subtypes of neglect, assessed the associations between subtypes of neglect subtypes and lifetime DSM-IV disorders in adults, and evaluated the independent associations between neglect and psychopathology after adjustment for parental psychopathology, other adverse experiences, recall bias, and social and demographic correlates. We found that childhood supervisory neglect is associated with negative mental health outcomes among exposed youth, independent of other demographic and familial risk factors. Furthermore, both paternal and maternal psychopathology demonstrated significant associations with neglect subtypes. These findings highlight the importance of neglect in characterizing childhood adversity, and demonstrate the importance of a broader conceptualization of childhood risk factors for adult psychopathology (Heaton et al, under review). Public Health Impact: These findings have provided novel knowledge on comparability of the structure of major depressive disorder in adults and adolescents. The central importance of symptoms that are somatic in quality (such as changes in appetite, weight, sleep and fatigue) in discriminating depressive subtypes has major implications for our understanding of the biologic pathways, treatment and opportunities for prevention of the consequences of this major public health problem in American youth. The findings have also made contribution to the nosology of depression, and provided support for retention of atypical specifier in the new DSM-5 by demonstrating its distinct biological correlates and treatment response. The strong links we found between neglect and long standing psychiatric disorders have provided insights on importance of early intervention. Expansion of empirical inquiry into the associations between paternal, as well as maternal, risk factors and neglect in population based samples may provide advancements in both etiology and prevention. Future Plans: Our efforts on the NCS-R as an independent project have been significantly reduced over the past year, since the analyses of the most relevant topics to our research programs have been completed. However, we plan to keep using this rich nationally representative sample to conduct comparative analyses of symptom patterns, correlates and consequences of disorders shown in our parallel adolescent sample.