National Comorbidity Survey - Replication (NCS-R)

这项研究的主要目标是从最近完成的国家共病调查复制(NCS-R)中收集第一个具有全国代表性的关于DSM-IV MDD患病率和相关性的数据。研究设计是对来自48个毗邻的美国的18岁及以上成年人的概率家庭调查的直接访谈家庭调查。本次研究的受试者总数为9090人，回复率为79%。诊断性访谈是世卫组织综合国际诊断访谈(CIDI)，为收集DSM-IV的诊断标准而开发。使用DSM-IV结构化临床访谈(SCID)进行临床再访谈，以验证CIDI的诊断。 NCS研究计划包括与美国国家共病调查(NCS)相关的一系列调查。NCS基线自1990年秋季至1992年春季，是美国第一个具有全国代表性的心理健康调查，使用完全结构化的研究诊断访谈来评估DSM-III-R障碍的患病率和相关性。在2001-02年度(NCS-2)，正在重新访问基线的NCS受访者，以研究精神和物质使用障碍的病程模式和预测因素，并评估原发精神障碍在预测继发性物质障碍的发病和病程方面的效果。与此同时，正在全国范围内对10,000名受访者进行新一轮全国范围内的重复调查。NCS-R的目标是研究基线NCS中评估的各种变量的趋势，并获得关于基线NCS没有涉及的或涉及的深度不如我们目前所希望的一些专题的更多信息。一项针对10,000名青少年的调查(NCS-A)正在与NCS-R和NCS-2调查同时进行。NCS-A的目标是编制具有全国代表性的数据，说明青少年中精神障碍的流行情况和相关因素。NCS-R和NCS-A终于在世界上许多国家得到了推广。在世界卫生组织(WHO)世界精神健康调查倡议的支持下，NCS数据分析小组正在对这些调查进行集中的跨国分析。初步结果显示，16.2%的人终生(3260万-3510万美国成年人)和6.6%的人(1310万-1420万美国成年人)在12个月内。与社会人口相关的有女性、60岁以下、未婚、非黑人、失业和残疾。近四分之三的MDD患者患有焦虑、物质或冲动控制障碍。MDD在这些病例中只有一小部分是临时性的。患有重度-重度12个月MDD的受访者(占所有12个月MDD的38%)平均失职83.5天，而轻中度病例平均9.6天。虽然有很高比例(72.4%)的12个月重症病例得到了治疗，但只有少数人(36.9%)得到了足够的治疗。治疗充分性与部门有关，但与严重程度无关。与严重程度、治疗和治疗充分性相关的社会人口学因素远没有流行率相关因素多。综上所述，我们发现MDD是一种常见的、严重损害的疾病，广泛分布于人群中。对暂时性原发疾病的早期治疗可能有助于预防MDD。虽然最近治疗的大幅增加令人鼓舞，但治疗充分性低是一个令人担忧的问题。在强调筛查、检测和扩大治疗中的MDD病例数量的同时，需要同时强调提高质量。 NCS研究计划包括与美国国家共病调查(NCS)相关的一系列调查。NCS基线调查从1990年秋季至1992年春季，是美国第一个具有全国代表性的心理健康调查，使用完全结构化的研究诊断访谈来评估DSM-III-R障碍的患病率和相关性。在2001-02年度(NCS-2)，正在重新访问基线的NCS受访者，以研究精神和物质使用障碍的病程模式和预测因素，并评估原发精神障碍在预测继发性物质障碍的发病和病程方面的效果。与此同时，正在全国范围内对10,000名受访者进行新一轮全国范围内的重复调查。NCS-R的目标是研究基线NCS中评估的各种变量的趋势，并获得关于基线NCS没有涉及的或涉及的深度不如我们目前所希望的一些专题的更多信息。一项针对10,000名青少年的调查(NCS-A)正在与NCS-R和NCS-2调查同时进行。NCS-A的目标是编制具有全国代表性的数据，说明青少年中精神障碍的流行情况和相关因素。NCS-R和NCS-A终于在世界上许多国家得到了推广。在世界卫生组织(世卫组织)世界精神卫生调查倡议的主持下，国家统计数据分析小组正在对这些调查进行集中的跨国分析。 在过去的一年里，我们完成了2004年9月发表的方法论论文的撰写工作。我们还开始为我们的NIMH团队将主要负责的疾病开发诊断算法，包括情绪谱障碍、头痛和吸烟。我们还在调查精神和身体障碍对公众健康的影响，方法是计算具体可归因于各自障碍的损害程度。这项研究的出版物开始出现，我们预计将在明年完成其他几篇关键论文。

The key objective of this study is to collect the first nationally representative data on prevalence and correlates of DSM-IV MDD from the recently completed National Comorbidity Survey Replication (NCS-R).The study design is a direct interview household survey of a probability household survey of adults ages 18 and over from the 48 contiguous United States. The total number of subjects in the study is 9090, representing a 79% response rate. The diagnostic interview was the WHO Composite International Diagnostic Interview (CIDI), developed to collect diagnostic criteria for the DSM-IV. Clinical re-interviews were carried out with the Structured Clinical Interview for DSM-IV (SCID) to validate CIDI diagnoses. The NCS research program consists of a series of surveys associated with the U.S. National Comorbidity Survey (NCS). The baseline NCS, fielded from the fall of 1990 to the spring of 1992, was the first nationally representative mental health survey in the U.S. to use a fully structured research diagnostic interview to assess the prevalences and correlates of DSM-III-R disorders. The baseline NCS respondents are being reinterviewed in 2001-02 (NCS-2) to study patterns and predictors of the course of mental and substance use disorders and to evaluate the effects of primary mental disorders in predicting the onset and course of secondary substance disorders. In conjunction with this, an NCS Replication survey (NCS-R) is being carried out in a new national sample of 10,000 respondents. The goals of NCS-R are to study trends in a wide range of variables assessed in the baseline NCS and to obtain more information about a number of topics either not covered in the baseline NCS or covered in less depth than we currently desire. A survey of 10,000 adolescents (NCS-A) is being carried out in parallel with the NCS-R and NCS-2 surveys. The goal of NCS-A is to produce nationally representative data on the prevalences and correlates of mental disorders among youth. NCS-R and NCS-A, finally, are being replicated in a number of countries around the world. Centralized cross-national analysis of these surveys is being carried out by the NCS data analysis team under the auspices of the World Health Organization (WHO) World Mental Health Survey Initiative.The initial results indicate that 16.2% lifetime (32.6-35.1 million U.S. adults) and 6.6% 12-month (13.1-14.2 million U.S. adults). Sociodemographic correlates are female, younger than 60, unmarried, not black, unemployed, and disabled. Nearly three-fourths of MDD cases have comorbid anxiety, substance, or impulse control disorders. MDD is temporally primary in only a minority of these cases. Respondents with serious-severe 12-month MDD (38% of all 12-month MDD) averaged 83.5 days out of role, while mild-moderate cases averaged 9.6 days. Although a high proportion (72.4%) of serious-severe 12-month cases receive treatment, only a minority (36.9%) of treatment is adequate. Treatment adequacy is related to sector, but not severity. Sociodemographic correlates of severity, treatment, and treatment adequacy are far less numerous than the correlates of prevalence. In summary, we found that MDD is a common, seriously impairing, disorder that is widely distributed in the population. Early treatment of temporally primary disorders might be useful to prevent MDD. While the recent dramatic increase in treatment is encouraging, low treatment adequacy is a source of concern. The emphasis on screening, detection, and expansion of the number of MDD cases in treatment needs to be accompanied by a parallel emphasis on quality improvement. The NCS research program consists of a series of surveys associated with the U.S. National Comorbidity Survey (NCS). The baseline NCS, fielded from the fall of 1990 to the spring of 1992, was the first nationally representative mental health survey in the U.S. to use a fully structured research diagnostic interview too assess the prevalences and correlates of DSM-III-R disorders. The baseline NCS respondents are being reinterviewed in 2001-02 (NCS-2) to study patterns and predictors of the course of mental and substance use disorders and to evaluate the effects of primary mental disorders in predicting the onset and course of secondary substance disorders. In conjunction with this, an NCS Replication survey (NCS-R) is being carried out in a new national sample of 10,000 respondents. The goals of NCS-R are to study trends in a wide range of variables assessed in the baseline NCS and to obtain more information about a number of topics either not covered in the baseline NCS or covered in less depth than we currently desire. A survey of 10,000 adolescents (NCS-A) is being carried out in parallel with the NCS-R and NCS-2 surveys. The goal of NCS-A is to produce nationally representative data on the prevalences and correlates of mental disorders among youth. NCS-R and NCS-A, finally, are being replicated in a number of countries around the world. Centralized cross-national analysis of these surveys is being carried out by the NCS data analysis team under the auspices of the World Health Organization (WHO) World Mental Health Survey Initiative. During the past year we have completed writing the methodologic papers that were published in September, 2004. We have also begun to develop diagnostic algorithms for the disorders for which our NIMH team will have primary responsibility including mood spectrum disorders, headache, and smoking. We are also investigating the public health impact of the mental and physical disorders by calculating the magnitude of impairment that is attributable specifically to respective disorders. Publications from this study are beginning to emerge, and we expect to complete the several other key papers during the next year.