Prevalence and distinct correlates of anxiety, substance, and combined comorbidity in a multi-site public sector sample with bipolar disorder
Prevalence and distinct correlates of anxiety, substance, and combined comorbidity in a multi-site public sector sample with bipolar disorder
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DOI：
10.1016/j.jad.2004.11.009
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发表时间：
2005-04-01
影响因子：
6.6
通讯作者：
Hauger, R
中科院分区：
文献类型：
--
作者：
Bauer, MS;Altshuler, L;Hauger, R
背景：最近的数据显示双相情感障碍中焦虑和物质共病的高患病率。然而，很少有研究利用公共部门的样本，只有一项研究试图将每种类型的共病的贡献分开。方法：对328名住院的双相情感障碍退伍军人进行DSM-IV模块和自我报告的选择性结构化临床访谈。结果：共病很常见(当前：57.3%；终生：78.4%)，其中多项当前并存占29.8%。物质合并症的发生率与非退伍军人住院患者样本中通常报告的发生率相当(目前为33.8%，终生为72.3%)。选定的焦虑共患率超过其他住院患者样本，并且比发作性/复发性更慢性(当前38.3%，终生43.3%)。49%的创伤后应激障碍是由非战斗应激源引起的。当前物质共病的主要相关因素是较年轻的年龄、较差的婚姻状况和较高的当前就业能力。目前焦虑共病的相关因素仅有发病年龄较早、前一年抑郁发作次数较多、领取残疾抚恤金的比率较高以及自我报告的精神和身体功能较低。限制：这是对急性住院退伍军人的横断面分析。结论：不同的物质和焦虑共病的模式是显著的，可能由不同的神经生物机制所辅助。焦虑症的患病率、慢性和对功能的影响表明，有必要改善对这一双重诊断群体的认识和治疗。临床和研究干预应该认识到这些不同的共病模式，并提供“从患者出发”的个性化治疗。(C)2005 Elsevier B.V.保留所有权利。
Background: Recent data indicate high prevalence of both anxiety and substance comorbidity in bipolar disorder. However, few studies have utilized public sector samples, and only one has attempted to separate contributions of each type of comorbidity.Methods: 328 inpatient veterans with bipolar disorder across I I sites were assessed using selected Structured Clinical Interview for DSM-IV modules and self-reports.Results: Comorbidity was common (current: 57.3%; lifetime: 78.4%), with multiple current comorbidities in 29.8%. Substance comorbidity rate was comparable to rates typically reported in non-veteran inpatient samples (33.8% current, 72.3% lifetime). Selected anxiety comorbidity rates exceeded those in other inpatient samples and appeared more chronic than episodic/recurrent (38.3% current, 43.3% lifetime). 49% of PTSD was due to non-combat stressors. Major correlates of current substance comorbidity alone were younger age, worse marital status, and higher current employability. Correlates of current anxiety comorbidity alone were early age of onset, greater number of prior-year depressive episodes, higher rates of disability pension receipt, and lower self-reported mental and physical function. Combined comorbidity resembled anxiety comorbidity.Limitations: This is a cross-sectional analysis of acutely hospitalized veterans.Conclusions: Distinct patterns of substance and anxiety comorbidity are striking, and may be subserved by distinct neurobiologic mechanisms. The prevalence, chronicity and functional impact of anxiety disorders indicate the need for improved recognition and treatment of this other dual diagnosis group is warranted. Clinical and research interventions should recognize these divergent comorbidity patterns and provide individualized treatment built "from the patient out." (c) 2005 Elsevier B.V. All rights reserved.