Mental disorders as risk factors for later substance dependence: estimates of optimal prevention and treatment benefits.
Mental disorders as risk factors for later substance dependence: estimates of optimal prevention and treatment benefits.
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DOI：
10.1017/s0033291708004510
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发表时间：
2009-08
影响因子：
6.9
通讯作者：
Kessler, R. C.
中科院分区：
文献类型：
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作者：
Glantz, M. D.;Anthony, J. C.;Berglund, P. A.;Degenhardt, L.;Dierker, L.;Kalaydjian, A.;Merikangas, K. R.;Ruscio, A. M.;Swendsens, J.;Kessler, R. C.
尽管精神障碍已被证明可以预测随后的物质障碍，但尚不清楚是否可以通过针对先前精神障碍的大规模干预措施经济有效地预防物质障碍。虽然实验干预是解决这种不确定性的唯一方法，但逻辑上优先的一个问题是，精神障碍与随后的物质障碍的关联是否足够强，足以证明进行这种干预是合理的。我们在这里通过模拟来研究这个问题，以估计在几种以精神障碍为重点的假设干预方案下可以预防的物质障碍的数量。数据来自国家合并症调查复制，这是一项具有全国代表性的美国家庭调查，回顾性评估了 DSM-IV 精神和物质障碍的终生史和发病年龄。使用回顾性发病年龄报告进行生存分析，用于估计精神障碍与随后的物质依赖的关联。基于模型的模拟估计了几种假设干预场景中的效应大小。虽然针对精神障碍的成功干预可能会预防一定比例的物质依赖，但为预防单一物质依赖而必须进行治疗的精神障碍病例数量估计如此之高，以至于这不是预防物质依赖的经济有效的方法（焦虑情绪障碍的范围为 76-177，外化障碍的范围为 40-47）。治疗既往精神障碍并不是预防物质依赖的经济有效的方法。然而，预防物质依赖可能被认为是早发性精神障碍干预措施的一个重要的次要结果。
Although mental disorders have been shown to predict subsequent substance disorders, it is unknown if substance disorders could be cost-effectively prevented by large-scale interventions aimed at prior mental disorders. While experimental intervention is the only way to resolve this uncertainty, a logically prior question is whether the associations of mental disorders with subsequent substance disorders are strong enough to justify mounting such an intervention. We investigate this question here using simulations to estimate the number of substance disorders that might be prevented under several hypothetical intervention scenarios focused on mental disorders. Data come from the National Comorbidity Survey-Replication, a nationally representative US household survey that retrospectively assessed lifetime history and age-of-onset of DSM-IV mental and substance disorders. Survival analysis using retrospective age-of-onset reports was used to estimate associations of mental disorders with subsequent substance dependence. Simulations based on the models estimated effect sizes in several hypothetical intervention scenarios. Although successful intervention aimed at mental disorders might prevent some proportion of substance dependence, the number of cases of mental disorder that would have to be treated to prevent a single case of substance dependence is estimated to be so high that this would not be a cost-effective way to prevent substance dependence (in the range 76-177 for anxiety-mood disorders and 40-47 for externalizing disorders). Treatment of prior mental disorders would not be a cost-effective way to prevent substance dependence. However, prevention of substance dependence might be considered an important secondary outcome of interventions for early-onset mental disorders.