The epidemiology of major depressive disorder - Results from the National Comorbidity Survey Replication (NCS-R).
The epidemiology of major depressive disorder - Results from the National Comorbidity Survey Replication (NCS-R).
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DOI：
10.1001/jama.289.23.3095
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发表时间：
2003-06-18
影响因子：
120.7
通讯作者：
Wang, PS
中科院分区：
文献类型：
--
作者：
Kessler, RC;Berglund, P;Wang, PS
目的根据《精神疾病诊断和统计手册》第四版(DSM-IV)标准，以及最近完成的《国家共病调查复制》(NCS-R)中有关治疗和治疗充分性的研究模式和相关性，提出具有全国代表性的关于MDD患病率和相关性的数据。2001年2月至2002年12月进行。设定48名连续的美国家庭居民(N=9090)，他们年龄在18岁或以上，对NCS-R调查有反应。主要结果使用世界卫生组织(WHO)的综合国际诊断访谈(CIDI)衡量MDD的患病率和相关性，12个月的严重程度使用抑郁症状自评快速清单(QDS-SR)、Sheehan残疾量表(SDS)和WHO残疾评估量表(WHO-DAS)。结果CIDI MDD的终生患病率为16.2%(95%可信区间，15.1-17.3)(3260万-3510万美国成年人)，12个月患病率为6.6%(95%可信区间；5.9-7.3)(1310万-1420万美国成年人)。几乎所有12个月的CIDI病例都被独立地归类为有临床意义的病例，其中10.4%的病例为轻度，38.6%的病例为中度，38.0%的病例为重度，12.9%的病例为重度。平均发作时间16周(95%CI，15.1~17.3)。SID测量的角色损害是实质性的，59.3%的12个月严重或非常严重的角色损害病例表明。大多数终生(72.1%)和12个月(78.5%)的病例有CIDI/DSM-IV并存的疾病，MDD很少是原发的。虽然51.6%(95%氯，46.1-57.2)的12个月病例接受了医疗保健治疗，但只有41.9%(95%氯，35.9-47.9)的病例得到了适当的治疗，导致21.7%(95%氯，18.1-25.2)的12个月MDD得到了充分的治疗。结论重度抑郁障碍是一种常见的精神障碍，在人群中分布广泛，通常与症状严重程度和角色损害有关。虽然最近治疗的增加令人鼓舞，但治疗不足是一个严重的问题。在强调筛选和扩大治疗的同时，需要同时强调提高治疗质量。
Context Uncertainties exist about prevalence and correlates of major depressive disorder (MDD).Objective To present nationally representative data on prevalence and correlates of MDD by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria, and on study patterns and correlates of treatment and treatment adequacy from the recently completed National Comorbidity Survey Replication (NCS-R).Design Face-to-face household survey,conducted from February 2001 to December 2002.Setting The 48 contiguous United States.Participants Household residents ages 18 years or older (N =9090) who responded to the NCS-R survey.Main Outcome Measures Prevalence and correlates of MDD using the World Health Organization's (WHO) Composite International Diagnostic Interview (CIDI), 12-month severity with the Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR), the Sheehan Disability Scale (SDS), and the WHO disability assessment scale (WHO-DAS). Clinical reinterviews used the Structured Clinical Interview for DSM-IV.Results The prevalence of CIDI MDD for lifetime was 16.2% (95% confidence interval [CI], 15.1-17.3) (32.6-35.1 million US adults) and for 12-month was 6.6% (95% CI; 5.9-7.3) (13.1-14.2 million US adults). Virtually all CIDI 12-month cases were independently classified as clinically significant using the QIDS-SR, with 10.4% mild, 38.6% moderate, 38.0% severe, and 12.9% very severe. Mean episode duration was 16 weeks (95% Cl, 15.1-17.3). Role impairment as measured by SIDS was substantial as indicated by 59.3 % of 12-month cases with severe or very severe role impairment. Most lifetime (72.1 %) and 12-month (78.5%) cases had comorbid CIDI/DSM-IV disorders, with MDD only rarely primary. Although 51.6% (95% Cl, 46.1-57.2) of 12-month cases received health care treatment for MDD, treatment was adequate in only 41.9% (95% Cl, 35.9-47.9) of these cases, resulting in 21.7% (95% Cl, 18.1-25.2) of 12-month MDD being adequately treated. Sociodemographic correlates of treatment were far less numerous than those of prevalence.Conclusions Major depressive disorder is a common disorder, widely distributed in the population, and usually associated with substantial symptom severity and role impairment. While the recent increase in treatment is encouraging, inadequate treatment is a serious concern. Emphasis on screening and expansion of treatment needs to be accompanied by a parallel emphasis on treatment quality improvement.