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标题：Análisis longitudinal de la comorbilidad entre depresión y agresión: Cronicidad y severidad en sujetos de 11 a 13 años
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作者：RODOLFO GORDILLO ; VICTORIA DEL BARRIO ; MIGUEL ÁNGEL CARRASCO 等
期刊名称：Interdisciplinaria
印刷版ISSN：0325-8203
电子版ISSN：1668-7027
出版年度：2012
卷号：29
期号：1
页码：165-185
语种：Spanish
出版社：Centro Interamericano de Investigaciones Psicológicas y Ciencias Afines
摘要：La comorbilidad entre depresión y agresión infanto-adolescente ha sido contrastada básicamente a un nivel estadístico. Sin embargo, pocos estudios han comprobado de manera longitudinal otra de las premisas fundamentales que permite establecer la comorbilidad: la sinergia, es decir, la acción conjunta de dos o más trastornos que se traduce en una severidad y cronicidad superior a las generadas por la suma de los efectos individuales. Mediante un diseño longitudinal a lo largo de 3 años se examinó la severidad y cronicidad de un grupo de sujetos comórbidos depresivos - agresivos. Se analizaron los niveles de depresión y agresión, así como el papel del sexo en estas relaciones. La evaluación se realizó a través de autoinformes en una muestra de 525 sujetos de edades comprendidas entre los 11 y 13 años. La muestra fue aleatoriamente seleccionada de diferentes colegios de la Comunidad de Madrid (España). Los resultados muestran que la depresión y agresión se relacionan de manera estadísticamente significativa. Los sujetos comórbidos exhiben una cronicidad de ma yor duración en las respuestas agresivas que en las depresivas. La severidad en los sujetos comórbidos es mayor en las respuestas agresivas de tipo total y verbal, así como en las depresivas. El sexo no ejerce ningún efecto significativo. Se concluye que los datos indican la importancia de explorar la comorbilidad con diferentes tipos de agresión, especialmente la verbal, y en diferentes gru pos de edad. Se discute la necesidad de atender a los síntomas subyacentes al trastorno principal en afectados de larga duración, ya que a la expresión de uno de los trastornos puede subyacer la cronicidad asociada a la comorbilidad con importantes repercusiones para su diagnóstico y tratamiento.
其他摘要：The comorbidity between depression and aggression in children and adolescents is an issue that has sparked controversy as its existence has important implications for the validity of the classification systems, for the establishment of ex planatory models, the design of new treatments as well as in the final outcome which the comorbid person presents in these in comparison with conventional treatments. In addition, the prevalence rates in depressive-aggressive comorbidity are significant, oscillating between 7.97 and 10.91%. Therefore, the study of comorbidity becomes necessary and the lack of studies focusing on the subject comes as a surprise. Perhaps one of the main problems concerning the research of comorbidity lies in the fact that most of the studies do not validate the clinical criteria that focuses on the principle of synergy, as Clark and Watson had established in Tripartite model, since doing so would require longitudinal studies measuring the effects of a commorbid disorder in contrast to those where there is no comorbidity to be found. In addition to clinical judgment, the Tripartite model demands a further statistic indicating the existence of a significant correlation between those synergistic disorders, which is the one on which most studies have been focusing. This type of results, based solely on clinical judgment, mainly through cross-sectional studies, has not allowed to implement another type of results, as suggested by the Tripartite model, that would have helped to establish clinical and diagnostic criteria through dimensional self-assessment tools which are closer to a reality in child and adolescent assessment where comorbidity is rather the rule than the exception. Therefore, that kind of study, using a longitudinal design over a period of three years, will help expand those cross-sectional ones, which will allow for examining whether there is a significant association, as well as a synergy that attests to the existence of an aggressive-depressive comorbidity on both, statistical and clinical level. In order to do so this study examined the severity and chronicity of a group of comorbid depressiveaggressive persons. In addition, the levels of depression and aggression and the role of sex within these relationships were analyzed. The sample, randomly selected from different schools in the Community of Madrid (Spain), comprised 525 individuals ranging from 11 to 13 years old, 58.9% female, the family structure was mostly biparental (92%) and the vast majority belonged to a middle class environment (85%). Depression and aggression were assessed through specific types of self-report questionnaires for children and adolescents, both in their Spanish version. The results support the statistical basis, since depression and aggression exhibit a significant positive and moderate association ranging between .11 and .24, in which the fact that the found association was higher within verbal aggression than in the physical one among all ages with the exception of the group of subjects to testing aged 12 needs to be stressed. With regards to the clinical criteria, the results provide partial support, as comorbid subjects exhibit a longer duration in chronic aggressive symptoms than those other groups affected only by depression or aggression, while they are similar to those of merely depressive subjects in the symptoms indicating a depression. Regarding severity, comorbid subjects show a higher level within the field of totally and verbally aggressive symptoms, as well as in the depressive ones which makes their physical aggression comparable to the one found in the test group of total aggression, hence, the data partially support the clinical standard. The tested person’s sex, however, is of no significant meaning for the outcome. In conclusion, the data indicates the importance of exploring the comorbidity of different types of aggression, particularly the verbal one, and within different age groups...
关键词：Comorbilidad; Depresión; Agresión física y verbal; Infantil; Adolescente;Comorbidity; Depression; Aggression physical and verbal; Child; Adolescent