Risk Factors for Psychopathology in the WHO WMH Surveys

描述（由申请人提供）：本提案是根据PA-03-044（使用现有数据集的精神病理学危险因素）提交的，目的是对世界卫生组织世界精神卫生（WMH）调查中的危险因素进行全面集中的二次分析。世界卫生组织的调查是在27个国家进行的一套协调一致的社区精神病学调查，总共抽样人数接近20万。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27项调查中，大多数调查的资助目的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。国家内部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，开展集中的二次分析，以利用世界卫生组织数据的这种利用不足。这些二级分析将集中在精神流行病学家长期感兴趣的六个研究领域：(1)精神疾病的性别差异；(2)社会阶层与心理疾病的关系；(3)选择性交配对精神疾病发生过程和代际传递的影响；(4)童年逆境对成人精神疾病的长期影响；(5)暂时性原发性早发性精神障碍对继发性精神障碍发病和病程的影响；(6)创伤后应激障碍在创伤性生活事件对其他类型精神疾病影响中的中介作用。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六个调查领域中的每一个领域作出重要贡献。

DESCRIPTION (provided by applicant): This proposal is 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 27 countries with a combined sample size of nearly 200,000 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 27 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 data by carrying out centralized secondary analyses in collaboration with the international WMH investigators. These secondary analyses will focus on six 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; (3) patterns and effects of assortative mating on the course and intergenerational transmission of mental illness; (4) the long-term effects of childhood adversities on adult mental illness; (5) the effects of temporally primary early-onset mental disorders on the onset and course of subsequent secondary mental disorders; and (6) the role of PTSD in mediating the effects of traumatic life events on other types of mental illness. The unprecedented size and substantive richness of the WMH database will allow important contributions to be made in each of these six areas of investigation.