Risk Factors for Psychopathology in the WHO WMH Surveys

世界卫生组织 WMH 调查中的精神病理学危险因素

• 批准号: 7286972
• 负责人: RONALD C KESSLER
• 金额: $ 100万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-07-20 至 2010-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7286972
• 关键词: World Health Organization; child abuse; clinical research; disease /disorder proneness /risk; gender difference; health surveys; human data; international cooperation; longitudinal human study; mental disorder diagnosis; mental health epidemiology; meta analysis; pathologic process; psychopathology; social class; socioeconomics

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.

说明(由申请人提供)：本提案是针对PA-03-044(使用现有数据集进行精神病理学的风险因素)而提交的先前提案的第二次提交，目的是对世界卫生组织世界精神卫生调查中的风险因素进行全面的集中二级分析。WMH调查是一套协调的社区精神疾病流行病学调查，在28个国家进行，总样本量超过21.4万名受访者。该诊断工具是世卫组织综合国际诊断访谈(CIDI)的扩展版本。采访还包括一系列丰富的风险因素。这些调查都是由经过仔细培训和密切监测的非专业面谈人员进行的，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结构化临床访谈(SCID)的临床复评访谈正在对多个地点的子样本进行，以确认CIDI的诊断。28项调查中的大多数仅用于评估县内精神疾病的社会负担、未得到满足的治疗需求以及获得治疗的障碍。国内分析在很大程度上仅限于就这些基本问题编写政府报告。没有一个调查小组得到资助进行跨国比较分析。我们建议利用WMH调查数据未得到充分利用的情况，与国际WMH调查人员合作进行集中的二次分析。这些次级分析将集中在三个方面的研究，所有这些都是精神病学流行病学家长期感兴趣的：(1)精神疾病的性别差异；(2)社会阶层和精神疾病之间的联系；以及(3)童年逆境对成人精神疾病的长期影响。世界卫生组织数据库的规模之大和实质内容之丰富，将使其能够在这三个调查领域中的每一个领域都作出重要贡献。针对审阅者的评论，已经做出了三个主要的修改。第一，原本建议的调查范围由六条减至三条。其次，我们增加了第二名FTE医学人类学博士后研究员和一名高级医学人类学家联合调查员。第三，针对审查员的意见，这份经修订的文件大大扩大了数据分析计划说明的详细程度。