The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Waves 1 and 2: review and summary of findings.
The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Waves 1 and 2: review and summary of findings.
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DOI：
10.1007/s00127-015-1088-0
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发表时间：
2015-11
影响因子：
4.4
通讯作者：
Grant BF
中科院分区：
文献类型：
--
作者：
Hasin DS;Grant BF
NESARC是一项“第三代”精神疾病流行病学调查，综合了酒精和毒品使用以及问题的详细衡量标准，已成为超过850种出版物的数据来源。缺乏对NESARC调查结果及其影响的全面审查。NESARC是一项对43,093名参与者的调查，涵盖了酒精、药物和精神障碍、风险因素和后果。东北非洲安全与合作委员会的第一轮工作是在2001-2002年间进行的。三年后，对34,653名原始参与者进行了第二波后续重新访谈。利用SCOPUS和Pubmed检索NESARC的论文，并对其进行主题分类和总结。最常见的障碍是酒精和创伤后应激障碍，以及严重的抑郁症。女性有更多的内在性障碍，男性有更多的外在性障碍，尽管患有酒精障碍的男性(“性别差距”)的优势没有前几十年那么明显。一个种族/民族“悖论”(弱势少数群体的风险比白人低)仍然无法解释。年轻参与者患物质和人格障碍的风险更高，但不是单相抑郁或焦虑障碍。精神疾病的共病是广泛的，并经常形成潜在的跨诊断领域。自1991-1992年间，吸食大麻和处方药紊乱的风险增加，而吸烟减少，尽管吸烟减少在有共病的人中不那么明显。共病、社会支持和压力的关系预测了第一波和第二波之间的诊断状态的转变。童年虐待预测了精神病理学。酒精和药物使用障碍很少得到治疗；在预测不接受治疗方面，态度障碍(很少感觉到需要，感觉到酗酒耻辱，对疗效感到悲观)比经济障碍更重要。要了解共病和早期应激源的影响，需要进行包含生物成分的研究，例如遗传变异和脑成像。酒精和药物障碍缺乏治疗是由态度变量而不是经济变量预测的，这表明迫切需要公共和专业教育，以减少与这些障碍相关的耻辱，并增加对治疗选择的了解。
The NESARC, a “third generation” psychiatric epidemiologic survey that integrated detailed measures of alcohol and drug use and problems, has been the data source for over >850 publications. A comprehensive review of NESARC findings and their implications is lacking. NESARC was a survey of 43,093 participants that covered alcohol, drug and psychiatric disorders, risk factors, and consequences. Wave 1 of the NESARC was conducted in 2001-2002. Three years later, Wave 2 follow-up re-interviews were conducted with 34,653 of the original participants. Scopus and Pubmed were used to search for NESARC papers, which were sorted into topic areas and summarized. The most common disorders were alcohol and post-traumatic stress disorders, and major depression. Females had more internalizing disorders and males had more externalizing disorders, although the preponderance of males with alcohol disorders (the “gender gap”) is less pronounced than it was in previous decades. A race/ethnic “paradox” (lower risk among disadvantaged minorities than whites) remains unexplained. Younger participants had higher risk for substance and personality disorders, but not unipolar depressive or anxiety disorders. Psychiatric comorbidity was extensive and often formed latent trans-diagnostic domains. Since 1991-1992, risk for marijuana and prescription drug disorders increased, while smoking decreased, although smoking decreases were less pronounced among those with comorbidity. A nexus of comorbidity, social support, and stress predicted transitions in diagnostic status between Waves 1 and 2. Childhood maltreatment predicted psychopathology. Alcohol and drug use disorders were seldom treated; attitudinal barriers (little perceived need, perceived alcoholism stigma, pessimism about efficacy) were more important in predicting non-treatment than financial barriers. Understanding comorbidity and the effects of early stressors will require research incorporating biologic components, e.g., genetic variants and brain imaging. The lack of treatment for alcohol and drug disorders, predicted by attitudinal rather than financial variables, suggests urgent need for public and professional education to reduce the stigma associated with these disorders, and increase knowledge of treatment options.