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标题：Mild Cognitive Impairment in Early Life and Mental Health Problems in Adulthood
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作者：Chuan-Yu Chen ; John P. Lawlor ; Anne K. Duggan 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2006
卷号：96
期号：10
页码：1772-1778
DOI：10.2105/AJPH.2004.057075
语种：English
出版社：American Public Health Association
摘要：Objectives. We assessed the extent to which borderline mental retardation and mental retardation at preschool ages are related to emotional and behavioral problems in young adulthood. We also explored early risk factors for having mental health problems as a young adult that might be related to preschool differences in cognitive ability. Methods. We used data from a cohort of births studied in the Johns Hopkins Collaborative Perinatal Study and followed up in the Pathways to Adulthood Study. Preschool cognitive functioning was assessed at 4 years of age. Individual characteristics, psychosocial factors, and mental problems were prospectively evaluated from birth through young adulthood. Results. Children with subaverage cognitive abilities were more likely to develop mental health problems than their counterparts with IQs above 80. Inadequate family interactions were shown to increase 2- to 4-fold the risk of emotional or behavioral problems among children with borderline mental retardation. Conclusions. Subaverage cognitive functioning in early life increases later risk of mental health problems. Future research may help to delineate possible impediments faced at different developmental stages and guide changes in supportive services to better address the needs of children with borderline mental retardation. Mental retardation is a complex clinical condition with a heterogeneous etiology. 1 ^– 8 Depending on issues of definition, identification, and sampling, 1 ^, 4 ^, 9 estimated prevalence rates of mild mental retardation (IQ of 50–70) vary considerably from 1.7 to 79.3 per 1000, and rates of severe mental retardation (IQ below 50) range from 2.2 to 7.3 per 1000. 4 ^, 9 Individuals with cognitive impairment are known to be a high-risk group for mental health problems. 8 ^, 10 ^– 19 In the Isle of Wight Study, data derived from parental assessments showed that approximately 1 in 3 children and adolescents with IQs below 70 had psychiatric problems, compared with nearly 7% of those with normal cognitive abilities. 19 Similar elevated risks were observed among adults with mental retardation. 15 ^, 18 ^, 20 Most of the evidence regarding the co-occurrence of mental retardation with psychiatric disturbance or behavioral problems has come from cross-sectional and clinic- or service-based research 12 ^, 14 ^, 18 ^, 21 ; few population-based studies have addressed this issue prospectively. 13 ^, 16 Results of several studies have indicated that certain factors might account for increased occurrences of mental heath conditions among individuals with mental retardation, including brain dysfunction, psychosocial adversity, family-related stress, and stress related to mental retardation. 8 ^, 16 Of particular pertinence in this study is a line of research about increasing levels of stress observed as children with mental retardation expand their interpersonal relationships beyond family to school and community. 22 To develop effective policy interventions that reduce risks of mental health problems among those with mental retardation, it may be crucial to understand whether adult mental health is linked to cognitive ability in the preschool years, a period before children with mental retardation begin to face more complex developmental tasks and environmental demands. Emerging research suggests that higher risks of emotional and behavioral problems may not be limited to those with moderate and severe cognitive impairment. For example, using data from the United Kingdom National Child Development Study, Maughan et al. found that mild mental retardation in adolescence was associated with higher malaise scores (obtained from a 24-item affective symptomatology scale) but was not associated with emotional problems or elevated alcohol problem screening scores on the CAGE (Cut down, Annoyed, Guilty, Eyeopener) instrument in young adulthood. 16 It remains unclear whether these connections apply to those with borderline mental retardation. Individuals who are not considered “retarded” but whose cognitive ability is subaverage may experience increased levels of stress because they might have to struggle to meet average standards with respect to role performance and social expectations and might have no access to beneficial and supportive services such as special education for those labeled “mentally retarded.” 23 ^, 24 We assessed the association between pre-school cognitive ability and later occurrence of mental health–related problems, including possible variations in profiles of risk factors for emotional and behavioral problems in young adulthood. Such information may be helpful in designing preventive interventions to reduce school- or community-related difficulties among children with lower than average cognitive ability before they enter elementary school. 25 ^, 26