Lifetime prevalence, demographic risk factors, and diagnostic validity of nonaffective psychosis as assessed in a US community sample. The National Comorbidity Survey.
Lifetime prevalence, demographic risk factors, and diagnostic validity of nonaffective psychosis as assessed in a US community sample. The National Comorbidity Survey.
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DOI：
10.1001/archpsyc.1996.01830110060007
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发表时间：
1996-11
影响因子：
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通讯作者：
K. Kendler;Timothy J. Gallagher;J. Abelson;Ronald C. Kessler
中科院分区：
文献类型：
--
作者：
K. Kendler;Timothy J. Gallagher;J. Abelson;Ronald C. Kessler
背景：我们试图通过计算机分析的结构化访谈和一位资深临床医生来评估美国人群中非情感性精神病的终生患病率和人口统计学相关性。方法在全国共病调查中，对5877名受访者进行了精神病症状筛查。根据对筛查的反应，精神卫生专业人员进行了详细的后续访谈(n=454)。最初的筛查和临床复诊由一名资深临床医生复查。结果是狭义的(精神分裂症或分裂样障碍)和广义的(所有非情感性精神病)定义的精神病。结果28.4%的人认可一个或多个精神病筛查问题。通过计算机算法，狭义和广义精神病的终生患病率分别为1.3%和2.2%。在那些被计算机指定为狭义诊断的患者中，高级临床医生将狭义诊断和广义诊断分别指定为10%和37%。根据临床医生的诊断，狭义和广义精神病的终生患病率分别为0.2%和0.7%。非情感性精神病的临床医生诊断与低收入、失业、单身、离婚或分居的婚姻状况显著相关；而城市居住地的临床医生通过住院、抗精神病药物治疗、病程、持续损伤和思维障碍来预测计算机诊断的确认。结论社区样本中精神疾病的终生患病率估计受到评估和诊断方法的强烈影响。尽管使用计算机算法的结果在国家共病调查和流行病学流域研究中相似，但如此获得的诊断与临床诊断的一致性较差。在流行病学样本中准确评估精神疾病可能需要收集大量的背景信息以供临床医生审查。
BACKGROUND We seek to estimate lifetime prevalence and demographic correlates of nonaffective psychosis in the US population assessed by a computer-analyzed structured interview and a senior clinician. METHODS In the National Comorbidity Survey, a probability subsample of 5877 respondents were administered a screen for psychotic symptoms. Based on the response to this screening, detailed follow-up interviews were conducted by mental health professionals (n = 454). The initial screen and clinical reinterview were reviewed by a senior clinician. Results are presented for narrowly (schizophrenia or schizophreniform disorder) and broadly (all nonaffective psychoses) defined psychotic illness. RESULTS One or more psychosis screening questions were endorsed by 28.4% of individuals. By computer algorithm, lifetime prevalences of narrowly and broadly defined psychotic illness were 1.3% and 2.2%, respectively. Of those assigned a narrow diagnosis by the computer, the senior clinician assigned narrow and broad diagnoses to 10% and 37%, respectively. By clinician diagnosis, lifetime prevalence rates of narrowly and broadly defined psychosis were 0.2% and 0.7%, respectively. A clinician diagnosis of nonaffective psychosis was significantly associated with low income; unemployment a marital status of single, divorced, or separated; and urban residence Clinician confirmation of a computer diagnosis was predicted by hospitalization, neuroleptic treatment, duration of illness, enduring impairment, and thought disorder. CONCLUSIONS Lifetime prevalence estimates of psychosis in community samples are strongly influenced by methods of assessment and diagnosis. Although results using computer algorithms were similar in the National Comorbidity Survey and Epidemiologic Catchment Area studies, diagnoses so obtained agreed poorly with clinical diagnoses. Accurate assessment of psychotic illness in epidemiologic samples may require collection of extensive contextual information for clinician review.