Examining Pathways among Co-occurring Mental and Substance Use Disorders

描述（由申请人提供）： 这是一项R 01提案，用于使用酒精和相关疾病的国家流行病学研究（NESARC）对同时发生的精神和物质使用障碍进行3年研究。 拟议的研究的主要目的是检查从纯粹的途径，以及在人群中共同发生的精神和物质使用障碍。更具体地说，我们将（1）确定单纯和共同发生的精神和物质使用障碍的概况;（2）在已确定的概况中建立障碍的时间序列，以产生共同发生障碍的途径;（3）估计沿着这些途径的转移概率，并评估其在性别、年龄和种族/民族方面的变化;（4）估计原发性疾病的治疗对沿着这些途径转变为继发性疾病的概率的影响;（5）估计与共存疾病的不同特征和途径相关的经济后果。 NESARC的两个最显著的优势（即，疾病的严格测量和大样本量）使得这种研究共存疾病的新方法成为可能。该方法建立在已发表的关于常见精神疾病结构和双重诊断流行病学的研究结果的基础上，以提供关于多种并发疾病的主要途径和之间的首次系统研究。解决这些问题将有助于阐明（1）合并症的自然病程，并填补我们对多种疾病之间转换风险的理解中的描述性和病因学空白，（2）治疗对转换为继发性疾病风险的影响，以及（3）合并症的特定特征和途径对个人经济结果的影响程度。这些途径可能构成不同亚型的合并症，并为未来的流行病学，遗传学和治疗试验研究的目标。因此，这项研究的结果将为探索继发性精神和物质使用障碍的病因学和预防的后续研究建立一个强大的平台，解决这些疾病的个人和社会成本最大的患者人群。

DESCRIPTION (provided by applicant): This is an R01 proposal for a 3-year study of co-occurring mental and substance use disorders using the National Epidemiologic Study on Alcohol and Related Conditions (NESARC). The primary purpose of the proposed study is to examine the pathways from pure to, and among, co-occurring mental and substance use disorders in the population. More specifically, we will (1) identify profiles of pure and co-occurring mental and substance use disorders; (2) establish the temporal sequence of disorders within the identified profiles to generate the pathways to, and among, co-occurring disorders; (3) estimate the transition probabilities along these pathways and assess their variation by gender, age, and race/ethnicity; (4) estimate the impact of treatment of primary disorders on the probability of transitioning along these pathways to secondary disorders; and (5) estimate the economic consequences associated with different profiles of and pathways among co-occurring disorders. Two of the NESARC's most notable strengths (i.e., rigorous measurement of disorders and large sample size) make this novel approach to studying co-occurring disorders possible. The approach builds from published findings on the structure of common psychiatric disorders and the epidemiology of dual diagnoses to provide the first systematic research on the primary pathways to, and among, multiple co-occurring disorders. Addressing these questions will shed light on (1) the natural course of comorbidity and fill descriptive and etiologic gaps in our understanding of the risk of transitions between multiple disorders, (2) the impact of treatment on the risk of transitions to secondary disorders, and (3) the degree to which particular profiles of and pathways to co-occurring disorders influence personal economic outcomes. These pathways may constitute distinct subtypes of comorbidity and be targets for future epidemiologic, genetic, and treatment trial research. Thus, the results of this study will build a strong platform for probing subsequent research on the etiology and prevention of secondary mental and substance use disorders, addressing the patient population for whom the personal and societal costs of these disorders are the greatest.