AJP：儿童期分离焦虑障碍增加未来惊恐障碍发病率

　　有证据指出，儿童期分离焦虑或许与成年期精神障碍的发病风险增高有关。

　　《美国精神病学杂志》（The American Journal of Psychiatry）2013年5月17日在线发表的一项系统分析的结果表明，儿童期分离焦虑障碍可显著增加未来惊恐障碍和焦虑障碍的发病风险。

　　为评估儿童期分离焦虑障碍与未来精神病理学之间的联系，研究者在2011年12月对发表于PubMed, PsycINFO及Embase的相关研究进行了系统分析，包括对比分离焦虑患儿与其他儿童未来发生惊恐障碍、重度抑郁障碍、焦虑障碍及物质使用障碍的病例对照、前瞻性及回顾性队列研究。在随机效应模型中计算影响因素的合并比值比（pooled odds ratios）。

　　共计25项研究达到入选资格（共计14855名参与者）。对其中的20项研究进行系统分析后发现，患有分离焦虑障碍的儿童未来发展为惊恐障碍的可能性较高(OR=3.45,95% CI=2.37–5.03)。5项研究的分析结果指出，确诊的儿童期分离焦虑障碍增肌未来焦虑障碍的发病风险(OR=2.19,95% CI=1.40–3.42)。对发表偏倚进行校正后，14项研究的分析结果显示，儿童期分离焦虑障碍不会增加未来抑郁发病的风险(OR=1.06,95% CI=0.78–1.45)；5项研究的分析结果表明儿童期分离焦虑障碍不会增加物质使用障碍的发病风险(OR=1.27,95% CI=0.80–2.03)。进行亚组分析后发现对照组和样本种类的差别明显影响比值比的大小。研究者人为这些结果支持焦虑障碍的发展精神病理学概念模型。

The Separation Anxiety Hypothesis of Panic Disorder Revisited: A Meta-Analysis

Objective  

Evidence suggests that childhood separation anxiety disorder may be associated with a heightened risk for the development of other disorders in adulthood. The authors conducted a meta-analysis to examine the relationship between childhood separation anxiety disorder and future psychopathology.

Method  

PubMed, PsycINFO, and Embase were searched for studies published through December 2011. Case-control, prospective, and retrospective cohort studies comparing children with and without separation anxiety disorder with regard to future panic disorder, major depressive disorder, any anxiety disorder, and substance use disorders were included in the analysis. Effects were summarized as pooled odds ratios in a random-effects model.

Results  

Twenty-five studies met all inclusion criteria (14,855 participants). A meta-analysis of 20 studies indicated that children with separation anxiety disorder were more likely to develop panic disorder later on (odds ratio=3.45; 95% CI=2.37–5.03). Five studies suggested that a childhood diagnosis of separation anxiety disorder increases the risk of future anxiety (odds ratio=2.19; 95% CI=1.40–3.42). After adjusting for publication bias, the results of 14 studies indicated that childhood separation anxiety disorder does not increase the risk of future depression (odds ratio=1.06; 95% CI=0.78–1.45). Five studies indicated that childhood separation anxiety disorder does not increase the risk of substance use disorders (odds ratio=1.27; 95% CI=0.80–2.03). Of the subgroup analyses performed, differences in comparison groups and sample type significantly affected odds ratio sizes.

Conclusions  

A childhood diagnosis of separation anxiety disorder significantly increases the risk of panic disorder and any anxiety disorder. These results support a developmental psychopathology conceptualization of anxiety disorders.