Pathway among Co-occurring Mental/Substance Use Disorder

描述(由申请人提供)： 这是一项R01建议，利用国家酒精及相关疾病流行病学研究(NESARC)对精神障碍和物质使用障碍共发生的3年进行研究。 这项拟议研究的主要目的是研究人群中从单纯精神和物质使用障碍到精神和物质使用障碍共发生的途径。更具体地说，我们将(1)确定纯精神和物质使用障碍的概况；(2)在已确定的概况内建立障碍的时间序列，以生成通向共生障碍的途径和共生障碍之间的途径；(3)估计沿着这些途径的转变概率，并评估它们随性别、年龄和种族/民族的变化；(4)估计原发障碍的治疗对沿着这些途径过渡到继发性障碍的可能性的影响；以及(5)估计不同的共生障碍特征和途径相关的经济后果。 NESARC的两个最显著的优势(即对疾病的严格测量和大样本容量)使这种研究共生疾病的新方法成为可能。该方法建立在发表的关于常见精神障碍的结构和双重诊断的流行病学的研究成果的基础上，首次对多种共生疾病的主要途径和其中的主要途径进行了系统研究。解决这些问题将揭示(1)共病的自然过程，并填补我们对多种疾病之间过渡风险的描述性和病因学空白，(2)治疗对过渡到继发性疾病风险的影响，以及(3)共病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的共病亚型，并成为未来流行病学、遗传学和治疗试验研究的靶点。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和预防的后续研究建立一个强大的平台，解决对这些疾病的个人和社会代价最大的患者群体。

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.