Hierarchical models of psychopathology based on substantial numbers of lifetime diagnostic categories have not been sufficiently evaluated, even though such models have relevance for theories of disorder etiology, course, or prognosis. In this research, a hierarchical component model of 16 Axis I disorders is derived, and model elements are evaluated in terms of their ability to demonstrate distinct associations with several clinically-relevant variables. Participants were 816 randomly selected adolescents from the community who were repeatedly assessed for psychiatric disorders and associated risk and protective factors over a 14-year period. First-degree relatives were also interviewed to establish their lifetime psychiatric history. Patterns of lifetime comorbidity among 16 psychiatric disorders were described at five levels of organization. In addition to the broadest level that accounted for the most variance in disorder covariation, evidence was obtained at successive levels in the hierarchy for internalizing and externalizing broad-band domains that could be subdivided into more refined clusters. The validity and potential utility of the resultant hierarchical model were further supported by distinct associations that components at each level had with exposure to childhood adversities, psychiatric disorders among first-degree relatives, and psychosocial functioning at ~age 30. A large number of DSM Axis I disorders can be described within broad-band internalizing and externalizing domains, and further differentiation within these domains is possible and likely useful for some purposes. Implications of this research for conceptualizing relations among psychiatric disorders are discussed.

译文

基于大量终生诊断类别的心理病理学分层模型尚未得到充分评估,即使此类模型与疾病病因,病程或预后理论相关。在这项研究中,得出了16轴I疾病的分层成分模型,并根据模型元素证明其与几个临床相关变量的独特关联的能力来评估模型元素。参与者是816随机选择的来自社区的青少年,他们在14年的时间内反复评估了精神疾病以及相关的风险和保护因素。还采访了一级亲戚,以确定他们的终生精神病史。在五个组织级别上描述了16种精神疾病的终生合并症模式。除了在无序协变中占最大方差的最广泛水平外,还在层次结构中的连续水平上获得了证据,用于内部化和外部化宽带域,这些域可以细分为更精细的簇。所得分层模型的有效性和潜在效用得到了不同的关联的进一步支持,这些关联是每个级别的组成部分与儿童时期的逆境,一级亲属的精神疾病以及30岁时的心理社会功能有关。可以在宽带内在化和外在化域中描述大量的DSM轴I疾病,并且在这些域中进一步区分是可能的,并且可能对某些目的有用。讨论了这项研究对精神疾病之间的概念化关系的意义。

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