Risk Factors for Psychopathology in the WHO WMH Surveys

描述（由申请人提供）：该提案是对先前提案的第二次重新提交，该提案是根据PA-03-044（使用现有数据集的精神病理学风险因素）提交的，目的是对世界卫生组织世界精神卫生（WMH）调查中的风险因素进行全面集中的二次分析。世界卫生组织调查是在28个国家进行的一套协调一致的社区精神病学调查，共有21.4万多名受访者。该诊断工具是世卫组织综合国际诊断访谈（CIDI）的扩展版本。访谈还包括一个丰富的风险因素电池。这些调查都是由经过仔细培训和密切监测的非专业采访者进行的，并采用集中培训和质量控制监测，以最大限度地提高各地点数据的可比性。使用DSM-IV （SCID）的结构化临床访谈的临床重新评估访谈正在对许多地点的子样本进行管理，以确认CIDI诊断。在28项调查中，大多数的资助只是为了评估县内精神障碍的社会负担、未满足的治疗需求以及获得治疗的障碍。国内分析主要限于编写关于这些基本问题的政府报告。没有一个调查队的经费是用来进行跨国比较分析的。我们建议与世界卫生组织的国际调查人员合作进行集中的二次分析，以充分利用世界卫生组织调查数据的不足。这些二级分析将集中在精神流行病学家长期感兴趣的三个研究方向上：(1)精神疾病的性别差异；(2)社会阶层与心理疾病的关系；(3)童年逆境对成人心理疾病的长期影响。世界卫生组织数据库空前的规模和实质性的丰富性将使我们能够在这三个调查领域中的每一个领域作出重要贡献。根据审稿人的意见，我们做了三个主要的修改。首先，原先提议的调查项目从六个减少到三个。第二，我们增加了一名FTE医学人类学博士后和一名高级医学人类学家合作研究员。第三，根据审稿人的意见，在这次修订后的提交中，数据分析计划描述的详细程度得到了实质性的扩展。

DESCRIPTION (provided by applicant): This proposal is a second resubmission of an earlier proposal that was submitted in response to PA-03-044 (Risk Factors for Psychopathology Using Existing Data Sets) to carry out comprehensive centralized secondary analyses of risk factors in the World Health Organization World Mental Health (WMH) surveys. The WMH surveys are a coordinated set of community psychiatric epidemiological surveys in 28 countries with a combined sample size of over 214,000 respondents. The diagnostic instrument is an expanded version of the WHO Composite International Diagnostic Interview (CIDI). The interviews also include a rich risk factor battery. The surveys are all being carried out by carefully trained and closely monitored lay interviewers, with centralized training and quality control monitoring used to maximize comparability of data across sites. Clinical reappraisal interviews using the Structured Clinical Interview for DSM-IV (SCID) are being administered to sub-samples in a number of sites to confirm the CIDI diagnoses. Most of the 28 surveys are funded only to assess the within-county societal burden of mental disorders, unmet needs for treatment, and barriers to obtaining treatment. Within-country analyses are largely limited to preparing government reports on these basic issues. None of the survey teams is funded to carry out cross-national comparative analyses. We propose to capitalize on this under-use of the WMH survey data by carrying out centralized secondary analyses in collaboration with the international WMH investigators. These secondary analyses will focus on three lines of research, all of which have been of long-standing interest to psychiatric epidemiologists: (1) sex differences in mental illness; (2) the association between social class and mental illness; and (3) the long-term effects of childhood adversities on adult mental illness. The unprecedented size and substantive richness of the WMH database will allow important contributions to be made in each of these three areas of investigation. Three major changes have been made in response to reviewer comments. First, the number of originally proposed lines of investigation was reduced from six to three. Second, we added a second FTE medical anthropology postdoctoral fellow and a senior medical anthropologist Co-Investigator to the team. Third, the level of detail in the description of data analysis plans has been substantially expanded in this revised submission in response to reviewer comments.