Pediatric-Onset and Adult-Onset Separation Anxiety Disorder Across Countries in the World Mental Health Survey.
Pediatric-Onset and Adult-Onset Separation Anxiety Disorder Across Countries in the World Mental Health Survey.
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DOI：
10.1176/appi.ajp.2015.14091185
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发表时间：
2015-07
期刊：
影响因子：
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通讯作者：
Kessler RC
中科院分区：
文献类型：
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作者：
Silove D;Alonso J;Bromet E;Gruber M;Sampson N;Scott K;Andrade L;Benjet C;Caldas de Almeida JM;De Girolamo G;de Jonge P;Demyttenaere K;Fiestas F;Florescu S;Gureje O;He Y;Karam E;Lepine JP;Murphy S;Villa-Posada J;Zarkov Z;Kessler RC
DSM-5中取消了分离焦虑症的发病年龄标准，这使得使用跨国数据来审查分离焦虑症作为一种疾病的流行病学是及时的。在世界卫生组织(WHO)的世界精神健康调查中，样本包括18个国家的38,993名成年人。世卫组织综合国际诊断访谈用于评估一系列DSM-IV障碍，其中包括对分离焦虑症的扩展定义，允许在成年后发病。分析的重点是患病率、发病年龄、共病、发病和持久性的预测因素，以及与分离焦虑相关的角色损害。终生分离焦虑症在各国的平均患病率为4.8%(四分位数范围[第25-75百分位数]=1.4%-6.4%)，其中43.1%的终生起始年龄发生在18岁之后。早期分离焦虑症与随后发生的内化型和外部型DSM-IV障碍之间存在显著的时滞性关联，反之，这些障碍与随后发生的分离焦虑症之间存在显著的时滞性关联。其他持续显著的终生分离焦虑症预测因子包括女性、回顾报告的童年逆境和终生创伤事件。这些预测因子在儿童、青春期、成年期和不同国家的收入群体中对分离焦虑症的首发情况基本相似。12个月分离焦虑症的患病率大大低于终生患病率(占总样本的1.0%；四分位数范围=0.2%-1.2%)。严重的分离焦虑相关的12个月角色损害在有(42.4%)比没有(18.3%)12个月共病的情况下更常见。分离焦虑症是一种常见的高度共病的疾病，可在一生中发病。童年逆境和终生创伤是重要的前因，对角色功能的不利影响使其成为治疗的重要目标。
The age-at-onset criterion for separation anxiety disorder was removed in DSM-5, making it timely to examine the epidemiology of separation anxiety disorder as a disorder with onsets spanning the life course, using cross-country data. The sample included 38,993 adults in 18 countries in the World Health Organization (WHO) World Mental Health Surveys. The WHO Composite International Diagnostic Interview was used to assess a range of DSM-IV disorders that included an expanded definition of separation anxiety disorder allowing onsets in adulthood. Analyses focused on prevalence, age at onset, comorbidity, predictors of onset and persistence, and separation anxiety-related role impairment. Lifetime separation anxiety disorder prevalence averaged 4.8% across countries (interquartile range [25th–75th percentiles]=1.4%–6.4%), with 43.1% of lifetime onsets occurring after age 18. Significant time-lagged associations were found between earlier separation anxiety disorder and subsequent onset of internalizing and externalizing DSM-IV disorders and conversely between these disorders and subsequent onset of separation anxiety disorder. Other consistently significant predictors of lifetime separation anxiety disorder included female gender, retrospectively reported childhood adversities, and lifetime traumatic events. These predictors were largely comparable for separation anxiety disorder onsets in childhood, adolescence, and adulthood and across country income groups. Twelve-month separation anxiety disorder prevalence was considerably lower than lifetime prevalence (1.0% of the total sample; interquartile range=0.2%–1.2%). Severe separation anxiety-related 12-month role impairment was significantly more common in the presence (42.4%) than absence (18.3%) of 12-month comorbidity. Separation anxiety disorder is a common and highly comorbid disorder that can have onset across the lifespan. Childhood adversity and lifetime trauma are important antecedents, and adverse effects on role function make it a significant target for treatment.