Association of Mental Disorders With Subsequent Chronic Physical Conditions: World Mental Health Surveys From 17 Countries.
Association of Mental Disorders With Subsequent Chronic Physical Conditions: World Mental Health Surveys From 17 Countries.
复制标题
DOI：
10.1001/jamapsychiatry.2015.2688
复制
发表时间：
2016-02
期刊：
影响因子：
25.8
通讯作者：
Kessler RC
中科院分区：
文献类型：
--
作者：
Scott KM;Lim C;Al-Hamzawi A;Alonso J;Bruffaerts R;Caldas-de-Almeida JM;Florescu S;de Girolamo G;Hu C;de Jonge P;Kawakami N;Medina-Mora ME;Moskalewicz J;Navarro-Mateu F;O'Neill S;Piazza M;Posada-Villa J;Torres Y;Kessler RC
很明显，治疗环境中的精神障碍与慢性身体状况的发生率较高有关，但这是否适用于社区中的精神障碍，以及这些关联的普遍性（在一系列身体健康结果中），尚不清楚。这一信息对精神卫生保健和慢性身体疾病的初级预防具有重要意义。研究16种暂时性既往精神障碍与随后10种慢性身体疾病的发病或诊断之间的关系。从2001年1月1日至2011年12月31日，在17个国家（47 609人; 2 032 942人-年）对社区居住的成年人进行了18次面对面的横断面家庭调查。复合国际诊断访谈被用来回顾性地评估DSM-IV确定的精神障碍的终生患病率和发病年龄。从2012年1月3日至2015年9月30日进行数据分析。通过自我报告医生的诊断和发病或诊断的年份来确定身体状况的终身史。生存分析估计了时间上先前的精神障碍首次发作与随后的身体状况发作或诊断的关联。16种精神障碍与随后发生或诊断的10种身体状况之间的大多数关联具有统计学意义，比值比（OR）（95%CI）范围为1.2（1.0-1.5）至3.6（2.0-6.6）。校正精神障碍合并症后，相关性减弱，但情绪、焦虑、物质使用和冲动控制障碍仍与7种至所有10种身体状况的发作显著相关（OR [95%CI]为1.2 [1.1-1.3]至2.0 [1.4-2.8]）。在生命过程中经历的精神障碍数量的增加与所有10种身体状况的发病或诊断几率的增加显著相关，1种精神障碍的OR（95% CI）范围为1.3（1.1-1.6）至1.8（1.4-2.2），5种或以上精神障碍的OR（95%CI）范围为1.9（1.4-2.7）至4.0（2.5-6.5）。在人群归因风险估计中，特定精神障碍与1.5%至13.3%的身体状况发作相关。这些研究结果表明，各种精神障碍都与各种慢性身体状况的发病风险增加有关。目前改善精神障碍患者身体健康的努力可能过于狭隘地集中在患有最严重精神障碍的少数群体上。从精神障碍病程的早期开始，在初级和二级保健中，以慢性躯体疾病初级预防为目的的干预措施应最佳地纳入所有精神障碍的治疗。
It is clear that mental disorders in treatment settings are associated with a higher incidence of chronic physical conditions, but whether this is true of mental disorders in the community, and how generalized (across a range of physical health outcomes) these associations are, is less clear. This information has important implications for mental health care and the primary prevention of chronic physical disease. To investigate associations of 16 temporally prior DSM-IV mental disorders with the subsequent onset or diagnosis of 10 chronic physical conditions. Eighteen face-to-face, cross-sectional household surveys of community-dwelling adults were conducted in 17 countries (47 609 individuals; 2 032 942 person-years) from January 1, 2001, to December 31, 2011. The Composite International Diagnostic Interview was used to retrospectively assess the lifetime prevalence and age at onset of DSM-IV–identified mental disorders. Data analysis was performed from January 3, 2012, to September 30, 2015. Lifetime history of physical conditions was ascertained via self-report of physician’s diagnosis and year of onset or diagnosis. Survival analyses estimated the associations of temporally prior first onset of mental disorders with subsequent onset or diagnosis of physical conditions. Most associations between 16 mental disorders and subsequent onset or diagnosis of 10 physical conditions were statistically significant, with odds ratios (ORs) (95% CIs) ranging from 1.2 (1.0–1.5) to 3.6 (2.0–6.6). The associations were attenuated after adjustment for mental disorder comorbidity, but mood, anxiety, substance use, and impulse control disorders remained significantly associated with onset of between 7 and all 10 of the physical conditions (ORs [95% CIs] from 1.2 [1.1–1.3] to 2.0 [1.4–2.8]). An increasing number of mental disorders experienced over the life course was significantly associated with increasing odds of onset or diagnosis of all 10 types of physical conditions, with ORs (95% CIs) for 1 mental disorder ranging from 1.3 (1.1–1.6) to 1.8 (1.4–2.2) and ORs (95% CIs) for 5 or more mental disorders ranging from 1.9 (1.4–2.7) to 4.0 (2.5–6.5). In population-attributable risk estimates, specific mental disorders were associated with 1.5% to 13.3% of physical condition onsets. These findings suggest that mental disorders of all kinds are associated with an increased risk of onset of a wide range of chronic physical conditions. Current efforts to improve the physical health of individuals with mental disorders may be too narrowly focused on the small group with the most severe mental disorders. Interventions aimed at the primary prevention of chronic physical diseases should optimally be integrated into treatment of all mental disorders in primary and secondary care from early in the disorder course.