Chronic medical conditions in a sample of the general population with anxiety, affective, and substance use disorders.
Chronic medical conditions in a sample of the general population with anxiety, affective, and substance use disorders.
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患有焦虑、情感和药物滥用障碍的普通人群样本中的慢性疾病。
DOI：
10.1176/ajp.146.11.1440
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发表时间：
1989
期刊：
影响因子：
--
通讯作者：
Burnam,MA
中科院分区：
文献类型：
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作者：
Wells,KB;Golding,JM;Burnam,MA
方法国家精神卫生研究所（NIMH）流行病学集水区项目是一项关于精神疾病流行病学和卫生服务使用的多地点一般人群调查（26，27）。在洛杉矶现场，从两个心理健康集水区（东洛杉矶和威尼斯/卡尔弗城）的家庭居民的阶段性概率样本。大约50%的受访者是西班牙裔（大多数是墨西哥裔美国人）（28）。对于每个家庭，随机选择一名成年人参加一系列面对面的采访。第一波面试于1982-1983年完成。应答率为68%（N3，132）。受访者比相应的家庭人口更有可能是年轻人和西班牙裔（29）。本文报告了样本中所有墨西哥裔美国人和非西班牙裔白人的数据（N2，554）。通过NIMH诊断访谈表（DIS）获得精神疾病的数据（30-32）。对于终生和6个月的患病间隔，我们确定了任何情感障碍的存在（重性抑郁、心境恶劣或躁狂）、任何物质使用障碍（酒精或药物滥用或依赖），任何焦虑症（恐慌症，恐惧症，强迫症），以及DIS中评估的任何精神疾病。我们对慢性医学疾病的测量是15-项目组收集关于被调查者一生中是否曾患过特定疾病以及被调查者目前是否正在接受每种疾病治疗数据。医疗状况为1）慢性肺病（肺气肿、哮喘、其他慢性肺病）、2）糖尿病、3）心脏病、4）高血压、5）关节炎、6）身体残疾（截肢、瘫痪、出生缺陷、耳聋、失明）、7）癌症和8）中风和其他神经系统疾病。我们将目前患有医学疾病定义为目前患有该疾病或目前正在接受该疾病的治疗。访谈还收集了年龄、工作状况（由Nam-Powers工作状况量表评分）（33分）、性别、婚姻状况和种族（归类为墨西哥裔美国人或非西班牙裔白色人）等数据。我们使用交叉表来检查与没有任何终身精神疾病的患病率相比，任何终身精神障碍，任何情感障碍，任何焦虑症和任何物质使用障碍的人的八种慢性疾病的任何和每一种的终身患病率。我们对目前的医疗状况和最近的精神疾病进行了平行分析。由于我们担心慢性疾病的自我报告措施可能会夸大这些疾病的患病率，我们使用当前慢性疾病（目前正在接受治疗的疾病）的更保守定义进行了敏感性分析，主要结论没有变化。患病率估计值通过直接方法进行性别和年龄调整（34）。我们认为，对多重统计比较进行严格的校正，就像我们早期的研究（15）一样，对于这项研究来说过于保守，因为大量的重要发现和相关性的一致方向。因此，我们讨论了在0.05水平下具有显著性的结果，但也在表中注明了在0.01、0.005和0.001水平下结果是否具有显著性。
METHODThe National Institute of Mental Health(NIMH) Epidemiologic Catchment Area Program is a multisite general population survey of the epidemiology of psychiatric disorders and use of health services(26, 27). At the Los Angeles site, staged probability samples of household residents from two mental health catchment areas (East Los Angeles and Venice/Culver City) were drawn. Approximately 50% of the respondents were of Hispanic origin (mostly Mexican-American)(28).For each household, one adult was randomly selected to participate in a series of face-to-face interviews. The first wave of interviews was completed in 1982-1983. The response rate was 68%(N3, 132). Respondents were somewhat more likely than the corresponding household population to be young and Hispanic(29). This paper reports data on all Mexican-Americans and non-Hispanic whites in the sample(N2, 554). Data on psychiatric disorders were obtained with the NIMH Diagnostic Interview Schedule(DIS)(30-32). For lifetime and 6-month prevalence intervals, we determined the presence of any affective disorder (major depression, dysthymia, or mania), any substance use disorder(alcohol or drug abuse or dependence), any anxiety disorder(panic disorder, phobia, on obsessive-compulsive disorder), and any psychiatric disorder assessed in the DIS. Our measure of chronic medical disease was a 15-item battery that elicits data on whether the respondent has had specific medical conditions ever in his or her lifetime and whether the respondent is currently under medical care for each condition. The medical conditions were 1) chronic lung disease (emphysema, asthma, other chronic lung disease), 2) diabetes mellitus, 3) heart disease, 4) hypertension, 5) arthritis, 6) physical handicap(amputation, paralysis, birth defect, deafness, blindness), 7) cancer, and 8) stroke and other neurologic conditions. We defined having a current medical disease as either currently having the condition or being currently under care for the condition. The interview also elicited data on age, job status (scored by the Nam-Powers job status scale)(33), sex, marital status, and ethnicity(categorized as Mexican-American or non-Hispanic white). We used cross-tabulations to examine the lifetime prevalence of any and each of the eight chronic medical conditions in persons with any lifetime psychiatric disorder, any affective disorder, any anxiety disorder, and any substance use disorder relative to the prevalence in those without any lifetime psychiatric disorden. We conducted a parallel analysis for current medical condition and recent psychiatric disorder. Because we were concerned that the self-report measure of chronic medical conditions might overstate the prevalence of these conditions, we conducted a sensitivity analysis using a more conservative definition of a current chronic medical condition(having a condition that was currently under treatment), and there was no change in the major conclusions. Prevalence estimates were sex-and age-adjusted by a direct method(34). We thought that a strict correction for multiple statistical comparisons, as was done in our earlier study (15), was too conservative for this study because of the large number of significant findings and the consistent direction of the associations. Thus, we discuss findings that were significant at the 0.05 level but also note in the tables whether findings were significant at the 0.01, 0.005, and 0.001 levels.