Risk Factors for Psychopathology in the WHO WMH Surveys

描述（由申请人提供）：本提案是为了响应PA-03-044（使用现有数据集的精神病理学风险因素）而提交的，旨在对世界卫生组织世界精神卫生（WMH）调查中的风险因素进行全面的集中二级分析。WMH调查是在27个国家进行的一套协调的社区精神病学流行病学调查，总样本量接近20万名受访者。该诊断工具是世卫组织综合国际诊断访谈（CIDI）的扩展版本。访谈还包括丰富的风险因素电池。这些调查都是由经过认真培训和密切监测的非专业调查员进行的，并进行集中培训和质量控制监测，以最大限度地提高各地点数据的可比性。使用DSM-IV结构化临床访谈（SCID）的临床重新评估访谈正在对一些研究中心的子样本进行管理，以确认CIDI诊断。27项调查中的大多数调查的资助仅用于评估县内精神障碍的社会负担、未满足的治疗需求以及获得治疗的障碍。在国家内部，分析主要限于编写关于这些基本问题的政府报告。没有一个调查小组获得进行跨国比较分析的经费。我们建议与国际WMH调查人员合作，通过进行集中的二次分析来利用WMH数据的使用不足。这些二次分析将集中在六个方面的研究，所有这些都是精神病学流行病学家长期感兴趣的：（1）精神疾病的性别差异;（2）社会阶层与精神疾病之间的联系;（3）强迫性交配对精神疾病的病程和代际传播的模式和影响;（4）精神疾病的性别差异。（4）童年期逆境对成年期精神疾病的长期影响;（5）时间上原发的早发性精神障碍对继发性精神障碍的发病和病程的影响;（6）PTSD在创伤性生活事件对其他类型精神疾病影响中的中介作用。世界卫生组织数据库的空前规模和丰富内容将使我们能够在这六个调查领域中的每一个领域做出重要贡献。

DESCRIPTION (provided by applicant): This proposal is submitted in response to PA-03-044 (Risk Factors for Psychopathology Using Existing Data Sets) to carry out comprehensive centralized secondary analyses of risk factors in the World Health Organization World Mental Health (WMH) surveys. The WMH surveys are a coordinated set of community psychiatric epidemiological surveys in 27 countries with a combined sample size of nearly 200,000 respondents. The diagnostic instrument is an expanded version of the WHO Composite International Diagnostic Interview (CIDI). The interviews also include a rich risk factor battery. The surveys are all being carried out by carefully trained and closely monitored lay interviewers, with centralized training and quality control monitoring used to maximize comparability of data across sites. Clinical reappraisal interviews using the Structured Clinical Interview for DSM-IV (SCID) are being administered to sub-samples in a number of sites to confirm the CIDI diagnoses. Most of the 27 surveys are funded only to assess the within-county societal burden of mental disorders, unmet needs for treatment, and barriers to obtaining treatment. Within country analyses are largely limited to preparing government reports on these basic issues. None of the survey teams is funded to carry out cross-national comparative analyses. We propose to capitalize on this under-use of the WMH data by carrying out centralized secondary analyses in collaboration with the international WMH investigators. These secondary analyses will focus on six lines of research, all of which have been of long-standing interest to psychiatric epidemiologists: (1) sex differences in mental illness; (2) the association between social class and mental illness; (3) patterns and effects of assortative mating on the course and intergenerational transmission of mental illness; (4) the long-term effects of childhood adversities on adult mental illness; (5) the effects of temporally primary early-onset mental disorders on the onset and course of subsequent secondary mental disorders; and (6) the role of PTSD in mediating the effects of traumatic life events on other types of mental illness. The unprecedented size and substantive richness of the WMH database will allow important contributions to be made in each of these six areas of investigation.