Children at Risk for Anxiety Disorders: A Follow up Study

有焦虑症风险的儿童：一项后续研究

基本信息

批准号：
7211382
负责人：
JERROLD F ROSENBAUM
金额：
$ 65.45万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
1993
资助国家：
美国
起止时间：
1993-05-01 至 2009-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7211382
关键词：
Adolescence Adolescent Adult Affect Agoraphobia Alcohols Anxiety Anxiety Disorders Area Attention Behavior Behavioral inhibition Biological Child Child Psychiatry Child Psychology Childhood Clinical Clinical Trials Collaborations Comorbidity Competence Complement Conflict (Psychology)Constitutional Development Diagnostic Disease Disinhibition Disruptive Behavior Disorder Early Intervention Education Environment Exposure to Family Family Relationship Family Study Follow-Up Studies Foundations Functional disorder Genetic Goals High Prevalence Impairment Institute of Medicine (U.S.)Interdisciplinary Study Intervention Joints Jordan K-Series Research Career Programs Knowledge Laboratories Literature Major Depressive Disorder Measures Mediating Mediation Mental Depression Mental disorders Modeling Mood Disorders Moods National Institute of Mental Health Numbers Outcome Outcomes Research Panic Disorder Parents Perinatal Phobic anxiety disorder Population Positioning Attribute Predisposition Prevention program Preventive Intervention Process Psychiatry Psychopathology Public Health Qualifying Range Rate Recruitment Activity Reporting Research Research Personnel Resources Risk Risk Factors Sampling Score Secondary Prevention Separation Anxiety Severities Shapes Social Phobia Speech Spouses Staging Stimulus Substance Use Disorder Substance abuse problem Temperament Testing Time Toddler Work Youth base childhood anxiety cohort cost design developmental psychology early childhood follow-up functional outcomes genetic epidemiology indexing neglect neuroimaging parental monitoring peer prevent proband programs prospective psychosocial self esteem social stem trait

项目摘要

DESCRIPTION (provided by applicant): The proposed study is a 12-year follow-up of a large cohort (N=446) of offspring at risk for panic disorder (PD), and comparison offspring at risk for major depression (MD) or without vulnerability for mood or anxiety disorders. The children were originally recruited in toddler hood and early childhood, were reassessed in middle childhood (at Year 6), and will enter adolescence during the next wave. This sample is unique in that a) children were characterized extensively at Baseline, using laboratory measures of behavioral inhibition (BI) and assessments of nascent symptomatology well before they entered the period of risk for childhood anxiety disorders; b) proband parents underwent comprehensive assessments of their adult and childhood psychopathology, with careful attention to delineating episodes to which offspring might have been exposed; and c) to our knowledge, it represents the largest sample of children at risk for anxiety followed longitudinally to date. Our study is also unique in that it has spawned offshoots in several promising directions, including studies of the genetic bases of BI and of an early intervention for young children at risk for anxiety. Our ongoing goals have been to study whether it is possible to predict the development and sequence of anxiety disorders among children of parents with PD, as well as to identify risk factors for childhood psychopathology, including temperamental (behavioral inhibition or disinhibition [BD]), parental comorbidity, and psychosocial adversity factors which might influence or moderate risk. We have already identified increased risks in middle childhood for PD, agoraphobia, and multiple anxiety disorders in offspring of PD parents, for a range of anxiety, mood and disruptive behavior disorders in offspring of MD parents, for social anxiety in BI youngsters, and for disruptive behavior disorders in children with BD. We have also noted associations between risk for anxiety disorders and perinatal and psychosocial risk factors. Now, as the children enter adolescence, a period of heightened risk for onset of social phobia, PD, and MD, as well as alcohol and substance abuse, peer difficulties, and other psychosocial problems, we are in the exciting and unique position to answer questions about the specific vulnerabilities conferred by parental PD, parental MD, BI or BD, and pre-existing childhood disorders. We are also able to begin to ask why and how the risk factors we have identified early in childhood influence psychopathology or resiliency in adolescence, and in what ways they combine with protective factors in predicting outcome. These research questions are straightforward, yet they carry broad implications. Studies of high-risk children and adolescents are of the utmost major public health relevance, since the identification of predictors of psychopathology and substance use disorders can set the stage for targeted primary or secondary prevention programs. The identification of such predictors, whether constitutional or environmental, is essential if we are to understand why some children with biological or psychosocial risk factors remain healthy during adolescence and successfully negotiate developmental tasks of this period while others develop psychopathology or derailments in functioning. Careful articulation of the mechanisms by which such factors operate would enable the design of specific, efficient, and cost-effective interventions to prevent poor outcomes in adolescence, and would permit the targeting of scarce societal resources for populations most likely to benefit from such programs.

描述（由申请人提供）：拟议的研究是对一大群（N = 446）有惊恐障碍（PD）风险的后代进行的 12 年随访，并与有重度抑郁症（MD）或重度抑郁症（MD）风险的后代进行比较。没有情绪或焦虑障碍的脆弱性。这些孩子最初是在幼儿期和幼儿期招募的，在童年中期（六年级）重新进行评估，并将在下一波浪潮中进入青春期。该样本的独特之处在于：a) 在儿童进入儿童焦虑症风险期之前，使用行为抑制 (BI) 实验室测量和新生症状学评估，在基线上对儿童进行了广泛的表征； b)先证者父母对其成年和儿童精神病理学进行全面评估，并仔细注意描绘后代可能接触过的事件； c) 据我们所知，它代表了迄今为止纵向跟踪的最大的有焦虑风险的儿童样本。我们的研究的独特之处还在于它在几个有希望的方向上产生了分支，包括对 BI 遗传基础的研究以及对有焦虑风险的幼儿进行早期干预的研究。我们持续的目标是研究是否有可能预测父母患有帕金森病的孩子焦虑症的发展和顺序，以及确定儿童精神病理学的危险因素，包括气质（行为抑制或去抑制[BD]）、父母合并症以及可能影响或减轻风险的社会心理逆境因素。我们已经发现，PD父母的后代在童年中期患PD、广场恐怖症和多种焦虑症的风险增加，MD父母的后代患一系列焦虑、情绪和破坏性行为障碍的风险增加，BI青少年的社交焦虑风险增加， BD 儿童的破坏性行为障碍。我们还注意到焦虑症风险与围产期和心理社会风险因素之间的关联。现在，随着孩子们进入青春期，这个时期出现社交恐惧症、PD和MD、以及酗酒和药物滥用、同伴困难和其他心理社会问题的风险更高，我们处于令人兴奋和独特的位置来回答关于父母 PD、父母 MD、BI 或 BD 以及先前存在的儿童期疾病所带来的特定脆弱性的问题。我们还能够开始询问我们在儿童早期发现的风险因素为何以及如何影响青春期的精神病理学或弹性，以及它们以何种方式与保护性因素相结合来预测结果。这些研究问题很简单，但具有广泛的影响。对高危儿童和青少年的研究具有最重要的公共卫生相关性，因为确定精神病理学和药物滥用障碍的预测因素可以为有针对性的一级或二级预防计划奠定基础。如果我们要理解为什么一些具有生物或心理社会风险因素的儿童在青春期保持健康并成功地完成这一时期的发展任务，而另一些儿童则出现精神病理学或功能脱轨，那么识别这些预测因素（无论是体质因素还是环境因素）至关重要。仔细阐明这些因素的运作机制将有助于设计具体、高效和具有成本效益的干预措施，以防止青春期的不良后果，并允许将稀缺的社会资源瞄准最有可能从此类计划中受益的人群。