Social Consequences of Mental Disorders: A Ten-Year Follow-up Study

描述(由申请人提供)：过去的研究发现，常见的精神障碍与不良的社会后果之间存在很强的相关性，如辍学、青少年怀孕、失业、婚姻不稳定和角色功能障碍。然而，在美国，对这些关联的大多数研究都是基于横截面数据或选定的人群。横断面研究无法理清精神障碍和社会逆境之间可能存在的相互关联，基于选定样本的研究也不能推广到整个人群。需要具有代表性的全体人口样本中的前瞻性数据。在美国，关注心理健康的此类研究很少。虽然在出生队列和其他工业化国家的其他纵向研究中已经研究了精神障碍与社会结果的关联，但背景因素的差异，如学校系统、就业市场和失业保险政策，阻碍了结果在美国的推广。有必要进行类似的美国研究，以证明精神障碍在美国的不良后果。在这个项目中，我们建议检查有情绪、焦虑、物质和行为障碍终生病史的5,001名美国国家共病调查基线年龄在15-54岁之间的5,001名参与者的不良社会和功能结果的发展，这些人接受了10年后的随访和重新采访。在目标1中，我们确定了基线精神障碍在多大程度上预示着随后的学校教育、就业和婚姻以及收入的中断。在目标2中，我们将重点放在先前存在的精神障碍与随后的角色功能障碍之间的联系。在目标3中，我们着眼于人口一级的社会逆境，并确定这些结果中可归因于人口一级精神障碍的比例。在目标4中，我们评估精神障碍与不良后果的关联是否因性别、社会经济状况和年龄而异。分析将使用倾向评分技术来调整在精神障碍发生之前观察到的潜在混杂因素，这可能解释与后续结果的关联。这项研究的结果可能有助于正在进行的关于投资于精神障碍研究和治疗的重要性的政策辩论，并可能有助于确定有针对性的干预亚群，以避免不利的社会后果。

DESCRIPTION (provided by applicant): Past research has found strong associations between common mental disorders and adverse social outcomes such as school drop-out, teen pregnancy, unemployment, marital instability and impairment in role functioning. However, most studies of these associations in the US have been based on cross-sectional data or selected populations. Cross-sectional studies cannot disentangle reciprocal associations likely to exist between mental disorders and social adversities and studies based on selected samples cannot be generalized to the whole population. Prospective data in representative samples of the entire population are needed. There are few such studies with a focus on mental health in the US. While the associations of mental disorders with social outcomes have been studied in birth cohort and other longitudinal studies in other industrialized countries, variations in contextual factors, such as school systems, job markets, and unemployment insurance policies hinder generalization of results to the US. There is a need for comparable US studies to document the adverse consequences of mental disorders in the US. In this project, we propose to examine the development of adverse social and functional outcomes in individuals with lifetime histories of mood, anxiety, substance and conduct disorders in the 5,001 participants of the US National Comorbidity Survey between ages 15-54 at baseline who were followed-up and re-interviewed 10 years later. In Aim 1 we determine the extent to which baseline mental disorders predict subsequent disruptions in schooling, employment and marriage as well as earnings. In Aim 2 we focus on the associations of pre-existing mental disorders with subsequent impairments in role functioning. In Aim 3 we look at social adversities at the population level and determine the proportion of these outcomes that can be attributed to mental disorders at the population level. In Aim 4, we assess whether the associations of mental disorders with adverse outcomes vary by sex, socio-economic status, and age. Analyses will use propensity score techniques to adjust for observed potential confounders preceding the onset of mental disorders that could explain associations with subsequent outcomes. Results of the study could be useful in ongoing policy debates about the importance of investing in research and treatment of mental disorders and could help identify subgroups for targeted intervention to avert adverse social outcomes.