National Comorbidity Survey - Replication (NCS-R)

在过去的一年里，我们完成了对NCS R数据的广泛分析，并就以下主题发表了大量论文：美国成年人口中双相情感障碍的患病率和相关因素；身体和精神障碍共病对角色残疾的影响；美国普通人群中偏头痛和紧张型头痛的共病情况、影响和模式；以及普通人群中物质使用障碍的风险因素和相关因素。 与我们的研究相关的这项工作的主要发现是，在人群中存在双相情感障碍的表现谱，证据表明阈值下双相情感障碍的临床有效性；双相情感障碍和其他精神障碍之间的共患率显著上升，以至于近三分之二的双相情感障碍患有药物使用障碍；使用一种新的分析方法来解释共病，我们估计了普通心理和身体状况对普通人群中角色残疾的比较影响。在控制了共病后，我们发现，在人口层面上，精神疾病导致的残疾天数是所有身体疾病的一半以上；在一般人群中，85%的偏头痛患者至少有一种终生精神或身体疾病。共病可以解释一半以上与偏头痛相关的角色残疾。 NCS-R数据还被应用于审查物质使用障碍流行病学中的基本问题。使用NCS-R和NCS1-2小组数据，我们的研究小组在过去的18个月里一直在研究物质使用障碍流行病学中的基本问题。第一系列手稿涉及酒精(Kalaydkin等人，印刷中)、烟草(Dierker等人，2008年)和非法物质(Swendsen等人，印刷中)不同阶段的社会人口风险因素。这些调查提供了关于与基于人口的风险因素最相关的药物使用轨迹的准确阶段的高度新颖的信息，这些知识对提高有选择和有指示的预防战略的精确度具有直接影响。第二系列手稿研究了物质类别和相关障碍之间的联系，包括特定物质可能增加其他类型物质使用或障碍风险的方式(例如，门户假说)，以及多物质使用或滥用的程度构成后来依赖的风险因素(Degenhardt等人，在印刷中；Swendsen，正在审查中)。这些研究首次表明，违反关口的行为在很大程度上与后来的依赖风险无关，但使用或滥用任何一种药物也会在随后的十年里大大增加所有其他形式的药物依赖的风险。最后，两篇手稿考察了共病精神病理学对物质使用障碍发病的风险(Swendsen，正在准备中)，以及通过针对指标性精神障碍的大规模干预来预防继发性物质依赖是否具有成本效益(Meyer等人，在印刷中)。这些调查的结果表明，尽管精神障碍经常在药物滥用和依赖的发生中发挥作用，但将指数性精神障碍作为减少药物依赖的一种手段，与其他预防选择相比，并不具有成本效益。 在过去的几个月里，我们已经开始使用一个维度框架来研究情绪障碍的光谱概念，以表征患有躁狂症和/或抑郁症的人。这项工作是与一个国际研究小组一起进行的，他们建议修改目前的诊断命名法，将双相情感障碍和重度抑郁症视为症状、持续时间、复发和严重程度的频谱，而不是作为独立的类别。我们的分析清楚地证实了频谱概念在基于诸如残疾、损伤、家族史、严重程度和共病模式等独立指数的普通人群样本中的有效性。 其他正在进行的工作包括评估家庭和婚姻因素在精神障碍的临床严重性、残疾和服务使用中的作用；将美国双相情感障碍的患病率与其他20个国家的可比数据进行比较；以及易怒作为双相情感障碍和严重抑郁症的指标的重要性。

During the past year, we have completed extensive analyses of the NCS R data and have published numerous papers on the following topics: the prevalence and correlates of bipolar spectrum disorder in the U.S. adult population; the impact of physical and mental disorder comorbidity on role disability; the prevalence, impact and patterns of comorbidity of migraine and tension-type headache in the U.S. general population, and the risk factors and correlates of substance use disorders in the general population. The major findings of this work that are relevant to our research are that there is a spectrum of expression of bipolar disorder in the population with evidence for clinical validity of sub-threshold bipolar disorder; comorbidity between bipolar disorder and other mental disorders is dramatically elevated such that nearly two-thirds of bipolars have a substance use disorder; using a novel analytic method that accounts for comorbidity, we estimated the comparative effects of common mental and physical conditions on role disability in the general population. After controlling for comorbidity, we found that mental conditions account for more than half as many disability days as all physical conditions at the population level; eighty-five percent of migraineurs in the general population have at least one other lifetime mental or physical disorder. Comorbidity explained more than half the role disability associated with migraine. The NCS-R data have also been applied to examine fundamental questions in the epidemiology of substance use disorders. Using the NCS-R and NCS1-2 panel data, our research group has worked over the past 18 months to examine fundamental questions in the epidemiology of substance use disorders. A first series of manuscripts addressed sociodemographic risk factors across diverse stages of alcohol (Kalaydjian et al, in press), tobacco (Dierker et al, 2008), and illicit substances (Swendsen et al., in press). These investigations 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. A second series of manuscripts examined associations among categories of substances and associated disorders, including the manner in which particular substances may increase the risk of other types of substance use or disorders (e.g. the gateway hypothesis) and the degree to polysubstance use or abuse constitutes a risk factor for later dependence (Degenhardt et al., in press; Swendsen, under review). These studies indicate for the first time that gateway violations are largely unrelated to later dependence risk, but also that the use or abuse of any single substance considerably increases the risk of all other forms of substance dependence over the subsequent decade. Finally, two manuscripts examine the risk posed by comorbid psychopathology for the onset of substance use disorders (Swendsen, in preparation) and whether it would be cost-effective to prevent secondary substance dependence by large-scale interventions aimed at index mental disorders (Meyer et al, in press). 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. During the past few months, we have begun to examine the spectrum concept of mood disorders using a dimensional framework to characterize people with mania and/or depression. This work is being conducted with a team on 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 analyses clearly confirm that 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. Other work in progress includes evaluation of the role of family and marital factors in clinical severity, disability, and service use for mental disorders; comparison of the prevalence of bipolar spectrum disorder in the U.S. with comparable data from 20 other countries; and the significance of irritability as an index of bipolar disorder and major depression.