National Comorbidity Survey - Replication (NCS-R)

全国合并症调查 - 复制 (NCS-R)

• 批准号: 7969380
• 负责人: kathleen r merikangas
• 金额: $ 40.34万
• 依托单位: NATIONAL INSTITUTE OF MENTAL HEALTH
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/7969380
• 关键词: Adolescent; Age; Age of Onset; Agreement; Alcohol or Other Drugs use; Alcohols; Anxiety Disorders; Attenuated; Bipolar Disorder; Cannabis; Categories; Child Abuse; Childhood; Clinical; Communities; Comorbidity; Country; DSM-IV; Data; Dependence; Depressive disorder; Development; Diabetes Mellitus; Diagnostic; Diagnostic and Statistical Manual of Mental Disorders; Disease; Doctor of Philosophy; Drug Addiction; Drug Use Disorder; Drug usage; Epidemiology; Evaluation; Family; Family Study; Family history of; Future; General Population; Heart Diseases; Household; Hypertension; Illicit Drugs; Impairment; Institutes; International; Intervention; Investigation; Knowledge; Link; Low income; Major Depressive Disorder; Manic; Measures; Mental Health; Mental disorders; Methodology; Michigan; Migraine; Mood Disorders; Moods; National Institute of Mental Health; Nomenclature; Obesity; Onset of illness; Paper; Pattern; Pharmaceutical Preparations; Physiological; Prevalence; Prevention; Prevention strategy; Psyche structure; Psychopathology; Public Health; Publishing; Recording of previous events; Recurrence; Relative (related person); Research; Research Personnel; Risk; Risk Factors; Role; Sampling; Series; Services; Severities; Sex Characteristics; Site; Sleep Disorders; Smoke; Staging; Structure; Substance Addiction; Substance Use Disorder; Substance abuse problem; Surveys; Symptoms; Time; Tobacco use; Universities; Vascular Diseases; Woman; Work; abuse neglect; base; cardiovascular risk factor; cost; depression; design; disability; disorder risk; disorder subtype; early onset; hypomania; improved; indexing; indicated prevention; meetings; men; novel; population based; prevent; secondary outcome; trend

During the past year, we have completed extensive analyses of the National Comorbidity Survey - Replication (NCS-R) data and have published numerous papers on the following topics: bipolar disorder with frequent mood episodes; bipolar spectrum disorder; the association between mood and anxiety disorder and vascular diseases and risk factors; mental disorders as risk factors for later substance dependence; examine socio-demographic predictors of transitions across drug use stages to improve targets for the prevention of drug use disorders; Associations between the order of drug use initiation and the development of drug dependence. We investigated the prevalence and correlates of a surrogate measure of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) rapid cycling BPD from NCS-R (Nierenberg et al, 2009). Virtually nothing is known about the epidemiology of rapid cycling bipolar disorder (BPD) in community samples. BPD with frequent mood episodes (FME) in NCS R was associated with younger age-of-onset (of bipolar 1 disorder (BP-I), but not bipolar 2 disorder (BP-II)) and higher annual persistence (73% of the years since first onset of illness with an episode) than non-FME BPD. No substantial associations of FME vs non-FME BPD were found with socio-demographics, childhood risk factors (parental mental disorders, other childhood adversities) or comorbid DSM-IV disorders. However, FME manic episodes had greater clinical severity than non-FME episodes (assessed with a fully structured version of the Young Mania Rating Scale) and FME hypomanic episodes had greater role impairment than non-FME episodes (assessed with the Sheehan Disability Scales). Whether these indicators of severity merely reflect attenuated effects of rapid cycling or independent effects of sub-threshold rapid cycling warrants further study given the high proportion of lifetime cases who met criteria for FME. We also conducted analyses on the spectrum concept of mood disorders using a dimensional framework to characterize people with mania and/or depression (Angst et al, in press). This work is being conducted with a team of international investigators who propose to modify the current diagnostic nomenclature by considering bipolar disorder and major depression as a spectrum of symptoms, duration, recurrence, and severity rather than as discrete categories. Our findings clearly confirm the validity of the spectrum concept in a general population sample based on independent indices such as disability, impairment, family history, severity and patterns of comorbidity. We assessed the association between mood and anxiety disorders with vascular diseases and risk factors using NCS-R data (Fedorowicz et al, ). Our results indicate vascular disease was associated with bipolar disorder in women, and major depressive disorder in men. When adjusted for anxiety disorders in examining the association between vascular disease and mood disorders, the association between mood disorder and vascular disease was attenuated but remained statistically significant for mania and hypomania, but not for major depressive disorder in women, and the association between major depression and vascular disease became non-significant in men. The independence of the associations between mood disorders and vascular disease from the well-established cardiovascular risk factors (diabetes mellitus, family history of heart disease, high blood pressure, smoking, and obesity) suggests the need for future research into physiological mechanisms by which vascular disease may be linked to mood or anxiety disorders. The sex differences in the links between vascular diseases and mood disorders, particularly bipolar disorder, should also stimulate further study to elucidate mechanisms for this important association. We compared the prevalence and correlates of the full spectrum of DSM-IV bipolar disorder in a series of nationally representative surveys from 11 countries using common methodology. Despite the differences in prevalence rates across countries, nearly 90% of those with lifetime BPI or BPII disorder also meet criteria for another lifetime disorder, and 70% of those with bipolar spectrum disorders have a history of three or more disorders. The findings demonstrate that the rates of bipolar disorder are fairly consistent worldwide, and confirm the dramatic impact and severity of this condition. The unmet need for services for bipolar disorder, particularly in low income countries is alarming (Merikangas et al). We examined the risk posed by comorbid psychopathology for the onset of substance use disorders and whether it would be cost-effective to prevent secondary substance dependence by large-scale interventions aimed at index mental disorders. The findings of these investigations demonstrate that, despite their frequent role in the onset of substance abuse and dependence, treating index mental disorders as a means reducing substance dependence would not be cost-effective relative to other prevention options. However, prevention of substance dependence might be considered an important secondary outcome of interventions for early-onset mental disorders. We have examined the role of pre-existing mental disorders and socio-demographics in explaining the predictive effects of violations using data from NCS R. The 'gateway' pattern of drug initiation describes a normative sequence, beginning with alcohol and tobacco use, followed by cannabis, then other illicit drugs. The findings indicate for the first time that drug use initiation follows a strong normative pattern, deviations from which are not strongly predictive of later problems. By contrast, adolescents who have already developed mental health problems are at risk for deviations from the normative sequence of drug initiation and for the development of dependence. Other work in progress includes evaluation of the role of migraine, sleep disorder, family and marital factors, childhood abuse and neglect in clinical severity, disability, comorbidity and service use for mental disorder from NCS R data; Latent class analysis on bipolar spectrum disorder to investigate whether it is dimensional or categorical. We also examine prospectively on bipolar spectrum disorder using NCS-baseline (1990) and NCS-II (2000) panel data. Public Health Impact: These investigations expand our knowledge on the magnitude and correlates of bipolar spectrum disorder and its relation to depressive disorder; they provide highly novel information concerning the precise stages of the substance use trajectory that are most associated with population-based risk factors, knowledge that has direct implications for improving the precision of selective and indicated prevention strategies.

在过去的一年里，我们完成了对国家合并症调查 - 复制 (NCS-R) 数据的广泛分析，并发表了有关以下主题的大量论文：频繁情绪发作的双相情感障碍；双相谱系障碍；情绪和焦虑障碍与血管疾病和危险因素之间的关联；精神障碍是日后物质依赖的危险因素；检查吸毒阶段转变的社会人口预测因素，以改善预防吸毒障碍的目标；药物使用开始顺序与药物依赖发展之间的关联。 我们调查了来自 NCS-R 的《精神疾病诊断与统计手册》第四版 (DSM-IV) 快速循环 BPD 的替代测量的患病率和相关性（Nierenberg 等，2009）。事实上，我们对社区样本中快速循环双相情感障碍 (BPD) 的流行病学一无所知。与非 FME BPD 相比，NCS R 中频繁情绪发作 (FME) 的 BPD 与较年轻的发病年龄（双相 1 型情感障碍 (BP-I)，但与双相 2 型情感障碍 (BP-II) 无关）和较高的年持续性（自首次发作发病以来的年数为 73%）相关。未发现 FME 与非 FME BPD 与社会人口统计学、儿童期危险因素（父母精神障碍、其他儿童期逆境）或共病 DSM-IV 疾病之间存在显着关联。然而，FME 躁狂发作比非 FME 发作（使用青年躁狂评定量表的完整结构化版本进行评估）具有更严重的临床严重性，并且 FME 轻躁狂发作比非 FME 发作（使用 Sheehan 残疾量表进行评估）具有更大的角色损害。鉴于符合 FME 标准的终生病例比例很高，这些严重程度指标是否仅反映快速循环的减弱效应或亚阈值快速循环的独立效应值得进一步研究。 我们还使用维度框架对情绪障碍的谱概念进行了分析，以描述躁狂症和/或抑郁症患者的特征（Angst 等人，正在出版）。这项工作是由一组国际研究人员进行的，他们建议修改当前的诊断命名法，将双相情感障碍和重度抑郁症视为一系列症状、持续时间、复发和严重程度，而不是离散的类别。我们的研究结果清楚地证实了基于残疾、损伤、家族史、严重程度和共病模式等独立指标的一般人群样本中频谱概念的有效性。 我们使用 NCS-R 数据评估了情绪和焦虑障碍与血管疾病和危险因素之间的关联（Fedorowicz 等人）。 我们的研究结果表明，血管疾病与女性双相情感障碍和男性重度抑郁症相关。当在检查血管疾病和情绪障碍之间的关联时对焦虑症进行调整时，情绪障碍和血管疾病之间的关联减弱，但对于躁狂和轻躁狂仍然具有统计学显着性，但对于女性的重度抑郁症则不然，而重度抑郁症和血管疾病之间的关联在男性中变得不显着。 情绪障碍和血管疾病之间的关联与公认的心血管危险因素（糖尿病、心脏病家族史、高血压、吸烟和肥胖）无关，这表明未来需要研究血管疾病可能与情绪或焦虑障碍相关的生理机制。 血管疾病和情绪障碍（尤其是双相情感障碍）之间联系的性别差异也应该激发进一步的研究，以阐明这种重要关联的机制。 我们使用通用方法，在 11 个国家进行的一系列具有全国代表性的调查中，比较了 DSM-IV 双向情感障碍全谱系的患病率和相关性。 尽管各国的患病率存在​​差异，但近 90% 的终生 BPI 或 BPII 障碍患者也符合另一种终生障碍的标准，70% 的双相谱系障碍患者有三种或以上疾病史。 研究结果表明，全球双相情感障碍的发病率相当一致，并证实了这种疾病的巨大影响和严重程度。双相情感障碍服务的未满足需求，特别是在低收入国家，令人震惊（Merikangas 等）。 我们研究了共病精神病理学对物质使用障碍发作造成的风险，以及通过针对指标精神障碍的大规模干预措施来预防继发性物质依赖是否具有成本效益。 这些调查的结果表明，尽管指标性精神障碍在药物滥用和药物依赖的发生中经常发挥作用，但与其他预防方案相比，将治疗指标性精神障碍作为减少药物依赖的手段并不具有成本效益。然而，预防物质依赖可能被认为是早发性精神障碍干预措施的一个重要的次要结果。 我们使用 NCS R 的数据研究了先前存在的精神障碍和社会人口统计学在解释违法行为的预测效果方面的作用。药物起始的“门户”模式描述了一个规范的顺序，从酒精和烟草的使用开始，然后是大麻，然后是其他非法药物。研究结果首次表明，吸毒开始遵循严格的规范模式，偏离该模式并不能有力地预测以后的问题。相比之下，已经出现心理健康问题的青少年有可能偏离正常的用药顺序并产生依赖性。 其他正在进行的工作包括根据 NCS R 数据评估偏头痛、睡眠障碍、家庭和婚姻因素、儿童虐待和忽视在临床严重程度、残疾、合并症和精神障碍服务使用中的作用； 双相谱系障碍的潜在类别分析，以研究它是维度的还是分类的。 我们还使用 NCS 基线 (1990) 和 NCS-II (2000) 面板数据对双相谱系障碍进行前瞻性研究。 公共健康影响：这些调查扩展了我们对双相情感障碍的严重程度和相关性及其与抑郁症关系的认识；它们提供了关于药物使用轨迹的精确阶段的高度新颖的信息，这些阶段与基于人群的风险因素最相关，这些知识对于提高选择性和指定预防策略的准确性具有直接影响。