The structure of common mental disorders
The structure of common mental disorders
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DOI：
10.1001/archpsyc.56.10.921
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发表时间：
1999-10-01
影响因子：
--
通讯作者：
Krueger, RF
中科院分区：
文献类型：
--
作者：
Krueger, RF
背景：本报告介绍了国家合并症调查中 10 种常见精神障碍的合并症模式的验证性因素分析结果，该调查是完成结构化诊断访谈的美国平民的全国概率样本。方法：通过对整个国家合并症调查样本（N = 8098；年龄范围，15-54 岁）的验证性因素分析，对 DSM-III-R 精神障碍中的合并症模式进行分析，样本的随机一半，分别针对男性和女性，以及向专业人士咨询心理健康问题的参与者子样本。比较了四种模型：1 因素模型、2 因素模型（其中一些疾病代表内化问题，另一些代表外化问题）、2 因素模型的 3 因素变体（其中内化被建模为具有 2 个子因素（焦虑-痛苦和恐惧））以及 4 因素模型（其中疾病代表单独的情感、焦虑、物质依赖和反社会因素）。 结果：3 因素模型在整个样本中提供了最佳拟合。这一结果在随机一半的样本以及女性和男性中得到了重复。焦虑-痛苦和恐惧之间的显着经验相关性（0.73）表明，这些因素最适合被视为高阶内化因素的子因素。在治疗样本中，二因素模型最适合。结论：结果为合并症提供了一个新的视角，表明合并症是由常见的、潜在的核心心理病理过程引起的。因此，研究结果主张将研究重点放在这些核心过程本身，而不是它们作为单独疾病的不同表现。
Background: This report presents the results of confirmatory factor analyses of patterns of comorbidity among 10 common mental disorders in the National Comorbidity Survey, a national probability sample of US civilians who completed structured diagnostic interviews.Methods: Patterns of comorbidity among DSM-III-R mental disorders were analyzed via confirmatory factor analyses for the entire National Comorbidity Survey sample (N = 8098; age range, 15-54 years), for random halves of the sample, for men and women separately, and for a subsample of participants who were seeing a professional about their mental health problems. Four mod els were compared: a 1-factor model, a 2-factor model in which some disorders represented internalizing problems and others represented externalizing problems, a 3-factor variant of the 2-factor model in which internalizing was modeled as having 2 subfactors (anxious-misery and fear), and a 4-factor model in which the disorders represented separate affective, anxiety, substance dependence, and antisocial factors.Results: The 3-factor model provided the best fit in the entire sample. This result was replicated across random halves of the sample as well as across women and men. The substantial empirical intercorrelation between anxious-misery and fear (0.73) suggested that these factors were most appropriately conceived as subfactors of a higher-order internalizing factor. In the treatment sample, the 2-factor model fit best.Conclusions: The results offer a novel perspective on comorbidity, suggesting that comorbidity results from common, underlying core psychopathological processes. The results thereby argue for focusing research on these core processes themselves, rather than on their varied manifestations as separate disorders.