注意力不足過動症與焦慮症及憂鬱症之共患關係:健保資料庫分析結果

研究動機與目的:鑑於臨床工作常見憂鬱或焦慮患者提及幼年有類似注意力不足過動症(ADHD-like)症狀,作者以健保資料庫為材料, 研究過動症、憂鬱及焦慮之關係。方法:首先運用資料探勘技術之”關聯規則”分析全國健保門診診斷記錄檔,篩檢出2001年全部18,321 名ADHD實驗組及四倍人數之對照組,依照Apriori運算法測檢測其2000年至2002年間不同共患疾患之間相關強度。接續則收集1999至2003年間5%隨機抽樣健保資料庫2,385名新診斷ADHD之實驗組及9,540名對照組個案,分析其1997年至2007年之焦慮症及其他精神疾患共患記錄,以存活分析比較兩組共患焦慮症之危險率及影響因子。結果:關聯規則分析發現過動症與焦慮症相關強度明顯(support: 13.37%; confidence 91.89%),同時顯示憂鬱症對過動症與焦慮症均有較弱之相關關係。存活分析結果發現大部份過動症組之焦慮症(421/445人)診斷均發生在過動症診斷之後,有顯著時序關係(Hazard ratio=15.83)。結論:本研究發現部份過動兒(17.7%)可能共患焦慮症;且有顯著時序關係-多發生在在初次診斷ADHD後平均1.4年;再根據相關文獻研究結果,推論這類兒童可能存在”過動-焦慮-憂鬱”的連續關係。作者提出及早治療過動症可能避免此”過動-焦慮-憂鬱”時序關係發生。本研究結果提供臨床篩檢及治療之重要參考,並同時展示資料探勘在大型臨床資料共患疾病研究之可行性,顯示未來應有更廣泛運用之可能。

關鍵字

過動症；焦慮症；憂鬱症；健保資料庫

並列摘要

Objectives: Regarding patients with depression or anxiety in clinics frequently mentioned their symptoms of Attention Deficit/ Hyperactivity Disorder (ADHD) in their early lives, this study was aimed to explore and confirm their temporal relationships based on Taiwan National Health Insurance Database (NHIRD). Methods: We applied Association Rule Mining (ARM) model to analysis all psychological diagnoses in claims data of 18,321 youngsters of ADHD in 2001 and their 73,328 matched controls. To explore further temporal relationship between ADHD and anxiety disorders (ANXs), we recruited 2,385 cases of newly diagnosis as ADHD and 9,540 matched controls in a 5% randomly selected dataset from year 1997 to 2007. A survival analysis was implemented for the longitudinally observed outcome as the first diagnosis of ANXs from year 1999 to 2003. Results: In ARM analysis, ANXs had a strong relationship with ADHD (support: 13.37%; confidence 91.89%) and there were weaker associations from depression to both ADHD and ANXs. The Cox proportional hazard model revealed a significant prediction of ADHD to ANXs (Hazard ratio =15.83) after controlling for the effects from other psychiatric disorders. Conclusions: Our finding of a significant prediction of ADHD to ANXs supports a temporal relationship from ADHD to ANXs. Combining with previous evidences, we proposed an ADHD- ANXs-depression temporal relationship, which strengthens our ARM result and indicates the importance of early treatment. This study also demonstrated the practicality of ARM in comorbidity studies using large clinic claims databases like NHIRD and surely guarantees further data-mining applications in this field.

並列關鍵字

ADHD ； Anxiety ； Depression ； NHIRD

參考文獻

Achenbach, T. M., Howell, C. T., McConaughy, S. H., & Stanger, C. (1995). Six-year predictors of problems in a national sample of children and youth: I. Cross-informant syndromes. J Am Acad Child Adolesc Psychiatry, 34(3), 336-347.

Ahmad, I., Hoessli, D. C., Qazi, W. M., Khurshid, A., Mehmood, A., Walker-Nasir, E., . . . Shakoori, A. R. (2008). MAPRes: an efficient method to analyze protein sequence around post-translational modification sites. J Cell Biochem, 104(4), 1220-1231.

Anastopoulos, A.D., Spisto, M.A., & Maher, M.C. (1994). The WISC-III Freedom from Distractibility factor: Its utility in identifying children with attention deficit hyperactivity disorder. Psychological Assessment, 6, 368-371.

Anderson, J. C., Williams, S., McGee, R., & Silva, P. A. (1987). DSM-III disorders in preadolescent children. Prevalence in a large sample from the general population. Arch Gen Psychiatry, 44(1), 69-76.

Angold, A., Costello, E. J., & Erkanli, A. (1999a). Comorbidity. J Child Psychol Psychiatry, 40(1), 57-87.

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注意力不足過動症與焦慮症及憂鬱症之共患關係:健保資料庫分析結果

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