Comorbidity within mental disorders: a comprehensive analysis based on 145 990 survey respondents from 27 countries
Comorbidity within mental disorders: a comprehensive analysis based on 145 990 survey respondents from 27 countries
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DOI：
10.1017/s2045796020000633
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发表时间：
2020-01-01
影响因子：
8.1
通讯作者：
de Jonge, P.
中科院分区：
文献类型：
--
作者：
McGrath, J. J.;Lim, C. C. W.;de Jonge, P.
流行病学研究表明，患有一种精神障碍的人随后患上其他类型精神障碍的风险增加。本研究的目的是进行一个全面的分析，成对的终身共病的一系列常见的精神障碍的基础上，各种各样的人口为基础的调查。方法世界卫生组织世界精神卫生（WMH）调查评估了来自27个国家的145 990名成年受访者。基于24种DSM-IV精神障碍的发病年龄的回顾性报告，研究了所有548种逻辑上可能的时间顺序障碍对之间的关联。使用考克斯比例风险模型计算总体和时间依赖性风险比（HR）和95%置信区间（CI）。绝对风险采用乘积限法进行估计。对男子和妇女的估计数是分别得出的。结果：每一种既往精神障碍都与随后每一种其他精神障碍首次发作的风险增加相关。中位HR为12.1（平均值= 14.4;范围5.2-110.8，四分位数间距= 6.0-19.4）。HR在密切相关的精神障碍类型之间以及在既往疾病发作后的前1-2年内最为突出。尽管HR自既往疾病后随时间下降，但随后合并症的风险显著升高持续至少15年。随着时间的推移，发现许多对患者继发性疾病的绝对风险明显增加。结论来自一系列站点的调查数据证实，精神障碍之间的共病是常见的。了解暂时继发性疾病的风险可能有助于设计实用的方案，一级预防继发性疾病。
Aims Epidemiological studies indicate that individuals with one type of mental disorder have an increased risk of subsequently developing other types of mental disorders. This study aimed to undertake a comprehensive analysis of pair-wise lifetime comorbidity across a range of common mental disorders based on a diverse range of population-based surveys. Methods The WHO World Mental Health (WMH) surveys assessed 145 990 adult respondents from 27 countries. Based on retrospectively-reported age-of-onset for 24 DSM-IV mental disorders, associations were examined between all 548 logically possible temporally-ordered disorder pairs. Overall and time-dependent hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards models. Absolute risks were estimated using the product-limit method. Estimates were generated separately for men and women. Results Each prior lifetime mental disorder was associated with an increased risk of subsequent first onset of each other disorder. The median HR was 12.1 (mean = 14.4; range 5.2-110.8, interquartile range = 6.0-19.4). The HRs were most prominent between closely-related mental disorder types and in the first 1-2 years after the onset of the prior disorder. Although HRs declined with time since prior disorder, significantly elevated risk of subsequent comorbidity persisted for at least 15 years. Appreciable absolute risks of secondary disorders were found over time for many pairs. Conclusions Survey data from a range of sites confirms that comorbidity between mental disorders is common. Understanding the risks of temporally secondary disorders may help design practical programs for primary prevention of secondary disorders.