Estimating the incidence of psychosis in diverse settings
Estimating the incidence of psychosis in diverse settings
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估计不同环境下精神病的发病率
DOI：
10.1017/s0033291719003702
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发表时间：
2019
影响因子：
6.9
通讯作者：
Cohen A
中科院分区：
文献类型：
--
作者：
Cohen A
在最近的一篇论文中，安德森等人。（2019）证明了，"相对于基于人群的估计，仅限于专业精神病服务（加拿大安大略）的病例确定策略可能大大低估了非情感性精神障碍的发病率。这促使Hogerzeil和货车Hemert（2019）以及Edwards，Rodrigues和安德森（2019）就流行病学研究的设计如何影响发病率估计交换了意见。此外，Edwards et al.（2019）提出了四种类型的发病率，反映了估计值的得出方式：真实发病率（“整个人群的理论发病率”）;接触发病率（与卫生系统有过接触的人）;诊断发病率（从临床医生那里得到精神病诊断的人）;和治疗发病率（接受过精神病治疗的人）。我们主要关注的是，大多数确定精神病发病率的努力都发生在西欧国家（Jongsma等人，二〇一八年; Jongsma，Turner，Kirkbride，& Jones，2019），这些国家拥有发达的卫生系统，并向其广泛的人口提供某种程度上可获得的精神病和社会服务。鉴于这些情况，可以有把握地假设，尽管经过不同的时间，个人在开始出现精神病症状后会寻求医疗护理。然而，这一假设在资源匮乏的卫生系统中是不成立的，我们想强调我们在国际精神病研究计划中采取的设计策略。无畏的研究。org/），以努力减少真实发生率和确定发生率之间的差距。此外，这项工作提出了一个更简单，但普遍的，真正的和确定的发病率之间的区别，研究人员明确了用于识别病例的精确检测策略及其潜在的局限性。我们的研究正在印度金奈南部的集水区、尼日利亚伊巴丹的地方政府地区以及特立尼达和托巴哥的市政府进行。我们的目标是确定真正具有代表性的精神病患者样本，这要求我们在该计划的试点阶段，在每个这些地点开发全面的病例发现系统，这些地点在其卫生系统和社会文化背景的性质方面各不相同。我们以两种方式处理这项任务。首先，我们在每个地点进行焦点小组，以收集有关当地精神病概念的信息（Cohen等人，2016年）。对这些概念的理解已经被证明可以促进与可能正在经历精神病的社区成员的信息提供者的沟通（Shibre，泰费拉，摩根和阿莱姆，2010）。第二，我们使用了Kleinman（1980）的卫生系统模型，该模型假定“理解和管理疾病的三个不同但重叠的部门......专业人员（即医疗机构），民间（即精神和传统治疗师）和大众（即管理疾病的非正式努力，例如自我药疗，朋友和家人的建议等）”。- 在每个集水区建立保健提供者和信息提供者的综合名单（Morgan等人，2015年）。有了这些信息，我们为病例调查网络建立了更全面的结构，其范围超出了保健专业人员、公共和私人诊所和医院，还扩大到非政府组织、传统和精神治疗师以及关键的信息提供者。对于印度的网站，我们还聘请了几位女性，她们在集水区寻找...
In a recent paper, Anderson et al.(2019) demonstrated how,‘Case ascertainment strategies limited to specialized psychiatric services (in Ontario, Canada) may substantially underestimate the incidence of non-affective psychotic disorders, relative to population-based estimates.’This prompted correspondence in which Hogerzeil and van Hemert (2019) and Edwards, Rodrigues, and Anderson (2019) exchanged ideas about how the design of epidemiological research may influence incidence estimates. Furthermore, Edwards et al.(2019) proposed four types of incidence that reflect how estimates were derived: true incidence (‘the theoretical incidence in the entire population’); contact incidence (those who have had contact with a health system); diagnosed incidence (those who have received a diagnosis of psychosis from a clinician); and treated incidence (those who have received treatment for a psychotic disorder). Our primary concern is that the great majority of efforts to determine the incidence of psychosis have taken place in Western European countries (Jongsma et al., 2018; Jongsma, Turner, Kirkbride, & Jones, 2019) that have well-developed health systems and offer, to a broad crosssection of their populations, somewhat accessible psychiatric and social services. Given these contexts, it is somewhat safe to assume that individuals will, albeit after varying periods of time, seek medical care after beginning to experience symptoms of psychosis. However, this assumption is not valid in poorly resourced health systems and we would like to highlight the design strategies we have taken in INTernational REsearch Programme on Psychoses In Diverse Settings (INTREPID–https://www. intrepidresearch. org/) in an effort to reduce the gap between true and identified incidence. Moreover, this work suggests a more simplified, but universal, distinction between true and identified incidence, with researchers making explicit the precise detection strategies used to identify cases and the potential limitations of these. Our research is being conducted in catchment areas south of Chennai, India, local government areas of Ibadan, Nigeria, and municipalities of Trinidad and Tobago. Our aim to identify truly representative samples of persons with psychosis, required us, during the pilot phase of the program, to develop comprehensive systems of case-finding in each of these sites that were diverse with regard to the nature of their health systems and sociocultural contexts. We approached this task in two ways. First, we conducted focus groups in each site to collect information about local concepts of psychotic illness (Cohen et al., 2016). An understanding of such concepts has been demonstrated to facilitate communication with informants about community members who might be experiencing a psychotic illness (Shibre, Teferra, Morgan, & Alem, 2010). Second, we used Kleinman’s (1980) model of health systems–which posits ‘three distinct but overlapping sectors in which illness is understood and managed… the professional (ie medical establishment), folk (ie spiritual and traditional healers), and popular (ie informal efforts to manage illness, eg self-medication, advice from friends and family, etc.)’–to create comprehensive lists of health providers and informants in each catchment area (Morgan et al., 2015). With this information we created more comprehensive structures for case-finding networks that extended beyond health professionals, public and private clinics and hospitals, to non-governmental organizations, traditional and spiritual healers, and key informants. For the site in India, we also hired several women who traveled the catchment area in search of …
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估计精神分裂症治疗发生率时的设计选择
影响因子：
6.9
作者：
S. J. Hogerzeil;A. V. van Hemert
通讯作者：
A. V. van Hemert
影响因子：
6.9
作者：
Morgan, C.;John, S.;Cohen, A.
通讯作者：
Cohen, A.
探索埃塞俄比亚南部博拉纳牧民社区明显不存在精神病的混合方法随访研究。
影响因子：
73.3
作者：
T. Shibre;Solomon Teferra;C. Morgan;A. Alem
通讯作者：
A. Alem
影响因子：
4.4
作者：
Cohen A;Padmavati R;Hibben M;Oyewusi S;John S;Esan O;Patel V;Weiss H;Murray R;Hutchinson G;Gureje O;Thara R;Morgan C
通讯作者：
Morgan C