Lifetime and 12-month prevalence of bipolar spectrum disorder in the national comorbidity survey replication
Lifetime and 12-month prevalence of bipolar spectrum disorder in the national comorbidity survey replication
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DOI：
10.1001/archpsyc.64.5.543
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发表时间：
2007-05-01
影响因子：
--
通讯作者：
Kessler, Ronald C.
中科院分区：
文献类型：
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作者：
Merikangas, Kathleen R.;Akiskal, Hagop S.;Kessler, Ronald C.
内容：越来越多的人认识到，双相情感障碍（BPD）有一个表达谱，比传统的人口调查中发现的1% BP-I患病率更常见。目的：估计美国人口中双相情感障碍的患病率、相关因素和治疗模式。设计：直接访谈。设置：美国大陆的家庭。参与者：一个全国代表性的样本9282讲英语的成年人（年龄≥ 18岁）。主要结果测量：版本3.0的世界卫生组织的复合国际诊断访谈，一个完全结构化的外行管理的诊断访谈，被用来评估DSM-1V的寿命和12个月的轴I障碍。阈下BPD定义为反复发作的轻躁狂，无重性抑郁发作或症状少于阈下轻躁狂。临床严重程度的指标包括发病年龄，慢性，症状严重程度，功能障碍，合并症，和treatment.Results：终身（和12个月）患病率估计为1.0%（0.6%）的BP-I，1.1%（0.8%）的BP-II，和2.4%（1.4%）的阈下BPD。大多数阈值和亚阈值BPD的受访者与其他轴I障碍，特别是焦虑症的终身共病。临床严重程度和功能障碍的阈值比阈下BPD和BP-II比BP-I发作的重性抑郁症，但阈下的情况下仍然有中度至重度的临床严重程度和功能障碍。虽然大多数人与BPD接受终身专业治疗的情绪问题，使用抗躁狂药物是不常见的，特别是在一般的医疗settings.Conclusions：这项研究提出了第一个患病率估计的BPD频谱的概率样本的美国。阈下BPD是常见的，具有临床意义，在治疗环境中检测不足。BPD的不适当治疗是美国人口中的一个严重问题。明确的标准，需要定义亚阈值BPD为未来的临床和研究目的。
Context: There is growing recognition that bipolar disorder (BPD) has a spectrum of expression that is substantially more common than the 1% BP-I prevalence traditionally found in population surveys.Objective: To estimate the prevalence, correlates, and treatment patterns of bipolar spectrum disorder in the US population.Design: Direct interviews.Setting: Households in the continental United States.Participants: A nationally representative sample of 9282 English-speaking adults (aged >= 18 years).Main Outcome Measures: Version 3.0 of the World Health Organization's Composite International Diagnostic interview, a fully structured lay-administered diagnostic interview, was used to assess DSM-1V lifetime and 12-month Axis I disorders. Subthreshold BPD was defined as recurrent hypomania without a major depressive episode or with fewer symptoms than required for threshold hypomania. Indicators of clinical severity included age at onset, chronicity, symptom severity, role impairment, comorbidity, and treatment.Results: Lifetime (and 12-month) prevalence estimates are 1.0% (0.6%) for BP-I, 1.1% (0.8%) for BP-II, and 2.4% (1.4%) for subthreshold BPD. Most respondents with threshold and subthreshold BPD had lifetime comorbidity with other Axis I disorders, particularly anxiety disorders. Clinical severity and role impairment are greater for threshold than for subthreshold BPD and for BP-II than for BP-I episodes of major depression, but subthreshold cases still have moderate to severe clinical severity and role impairment. Although most people with BPD receive lifetime professional treatment for emotional problems, use of antimanic medication is uncommon, especially in general medical settings.Conclusions: This study presents the first prevalence estimates of the BPD spectrum in a probability sample of the United States. Subthreshold BPD is common, clinically significant, and underdetected in treatment settings. Inappropriate treatment of BPD is a serious problem in the US population. Explicit criteria are needed to define subthreshold BPD for future clinical and research purposes.