Testing an integrated model of population mental health: an incidence and inception cohort study

人口心理健康监测现在被认为在全球健康、危险因素和人口监测系统中发挥着至关重要的作用。采用公共精神卫生观点进行监测和监测，需要我们考虑精神疾病的整个范围，从严重的精神障碍到高危人群，再到积极的精神健康和福祉。在许多欧洲国家，这种人口心理健康方法已成为公共心理健康提供的支柱，但在过去20年里，德国对这一问题的研究一直很少，与这一方法有关的基本概念和方法问题仍有待在国家和国际一级加以解决。这项研究旨在通过测试涵盖整个精神疾病连续体的综合跨诊断模型的关键方面(即治疗发病率、临床阶段过渡、跨诊断维度、数字瞬时表型、人群平均水平)来建立和描绘人口心理健康的基本流行病学。为了实现这一目标，我们将利用尖端统计方法和数字技术，在德国两个严格定义的集水区(曼海姆、莱茵-内卡地区)建立一个高度创新的、基于人群的发病率和初始队列研究。在发病调查组，将使用严格的病例查明程序(包括泄漏研究)，在两年的病例确认期内，从两个集水区的大约853,816名高危人群中查明事件病例，这将相当于1,707,632人年的高危。在初始队列-ARM中，我们将在基线(T0)招募一组以人群为基础、具有流行病学特征的个人，他们符合严重精神障碍临床高危状态的标准(魅力，1b阶段)或非特定心理困扰(1a阶段)，以及不符合这些标准的个人(第0阶段)，方法是从与事件病例相同的集水区分层随机抽样。这一队列将在18个月内招募，每6个月跟踪一次，所有参与者的最短后续时间为12个月，相当于征聘和评估的总期限为2.5年。这将确保所有参与者在6个月(T1)和12个月(T2)进行跟踪，同时允许我们在可能的情况下收集18个月(T3)和24个月(T4)的数据，从而最佳地利用事件(生存)数据。这种双臂设计将使我们能够校准整个精神疾病的连续体，检查基本的概念和方法问题，建立全国范围内更全面地监测人口心理健康的设计和方法的可行性，从而为评估新的公共精神卫生服务在人口层面的影响提供基础。

Monitoring of population mental health is now considered to play a vital role in health, risk factor and demographic surveillance systems across the globe. Adopting a public mental health perspective on monitoring and surveillance requires us to consider the entire spectrum of mental-ill health, which broadly ranges from severe mental disorders via at-risk populations to positive mental health and well-being. This population mental health approach has become the mainstay of public mental health provision in many European countries, but there has been a dearth of research on this issue in Germany in the past 20 years, and fundamental conceptual and methodological issues remain to be addressed in relation to this approach at both the national and international level. The research aims to establish and delineate the basic epidemiology of population mental health by testing key aspects (i.e., treated incidence, clinical stage transitions, transdiagnostic dimensions, digital momentary phenotypes, population mean) of an integrated transdiagnostic model encompassing the entire continuum of mental ill-health. To achieve this, we will establish a highly innovative, two-arm population-based incidence and inception cohort study, in two tightly defined catchment areas (Mannheim, Rhine-Neckar-Region) in Germany using cutting-edge statistical approaches and digital technology. In the incidence arm, incident cases will be identified using rigorous case ascertainment procedures (including a leakage study) from around 853,816 persons at risk in the two catchment areas over a two-year case ascertainment period, which will provide an equivalent of 1,707,632 person-years at risk. In the inception cohort-arm, we will recruit, at baseline (t0), a population-based, epidemiologically characterized cohort of individuals, who meet criteria for a clinical high-risk state for severe mental disorder (CHARMS, stage 1b) or non-specific psychological distress (stage 1a), as well as individuals, who do not meet these criteria (stage 0), by selecting a stratified random sample from the same catchment areas as incident cases. This cohort will be recruited over a period of 18 months and followed every 6 months, with a minimum follow-up time of 12 months for all participants, corresponding to a total duration for recruitment and assessment of 2.5 years. This will ensure that all participants will be followed at 6 months (t1) and 12 months (t2), whilst allowing us to collect data, where possible, at 18 months (t3) and 24 months (t4), thereby making optimal use of time to event (survival) data. This two-arm design will allow us to calibrate the entire mental ill-health continuum, examine fundamental conceptual and methodological issues, establish nationwide feasibility of design and methods for more comprehensive monitoring of population mental health, and, thereby, provide the basis for assessing the impact of novel public mental health services at the population level.