National Comorbidity Survey - Replication (NCS-R)

本研究的主要目的是收集第一个全国代表性数据的患病率和相关的DSM-IV MDD从最近完成的全国科摩罗调查复制（NCS-R）。研究设计是一个直接的访谈家庭调查的概率家庭调查的成年人年龄在18岁及以上，从48个连续的美国。研究中的受试者总数为9090例，代表79%的缓解率。诊断访谈是WHO复合国际诊断访谈（CIDI），旨在收集DSM-IV的诊断标准。采用DSM-IV（SCID）结构化临床访谈进行临床再访谈，以验证CIDI诊断。 这项研究的初步结果于2003年7月发表。我们发现CIDI MDD患病率估计为16.2%终身（32.6-35.1百万美国成年人）和6.6% 12个月（13.1-14.2百万美国成年人）。社会人口学相关因素是女性，年龄小于60岁，未婚，非黑人，失业和残疾。近四分之三的MDD病例有焦虑、物质或冲动控制障碍的共病。MDD仅在少数病例中为时间原发性。12个月重度抑郁症患者（占所有12个月抑郁症患者的38%）平均有83.5天不工作，而轻度至中度病例平均有9.6天不工作。虽然很高比例（72.4%）的严重-严重12个月病例接受治疗，但只有少数（36.9%）的治疗是充分的。治疗充分性与部门有关，但与严重程度无关。严重程度、治疗和治疗充分性的社会人口学相关因素远少于患病率的相关因素。总之，我们发现MDD是一种常见的严重损害性疾病，广泛分布于人群中。早期治疗时间原发性疾病可能有助于预防MDD。虽然最近治疗人数的大幅增加令人鼓舞，但治疗不足是一个令人关切的问题。在强调筛查、检测和扩大治疗中MDD病例数量的同时，需要同时强调质量的提高。

The key objective of this study is to collect the first nationally representative data on prevalence and correlates of DSM-IV MDD from the recently completed National Comorbidity Survey Replication (NCS-R).The study design is a direct interview household survey of a probability household survey of adults ages 18 and over from the 48 contiguous United States. The total number of subjects in the study is 9090, representing a 79% response rate. The diagnostic interview was the WHO Composite International Diagnostic Interview (CIDI), developed to collect diagnostic criteria for the DSM-IV. Clinical re-interviews were carried out with the Structured Clinical Interview for DSM-IV (SCID) to validate CIDI diagnoses. The initial results of this study were published in July, 2003. We found that CIDI MDD prevalence estimates are 16.2% lifetime (32.6-35.1 million U.S. adults) and 6.6% 12-month (13.1-14.2 million U.S. adults). Sociodemographic correlates are female, younger than 60, unmarried, not black, unemployed, and disabled. Nearly three-fourths of MDD cases have comorbid anxiety, substance, or impulse control disorders. MDD is temporally primary in only a minority of these cases. Respondents with serious-severe 12-month MDD (38% of all 12-month MDD) averaged 83.5 days out of role, while mild-moderate cases averaged 9.6 days. Although a high proportion (72.4%) of serious-severe 12-month cases receive treatment, only a minority (36.9%) of treatment is adequate. Treatment adequacy is related to sector, but not severity. Sociodemographic correlates of severity, treatment, and treatment adequacy are far less numerous than the correlates of prevalence. In summary, we found that MDD is a common, seriously impairing, disorder that is widely distributed in the population. Early treatment of temporally primary disorders might be useful to prevent MDD. While the recent dramatic increase in treatment is encouraging, low treatment adequacy is a source of concern. The emphasis on screening, detection, and expansion of the number of MDD cases in treatment needs to be accompanied by a parallel emphasis on quality improvement.