Social Role Disability and Mental-Physical Co-Morbidity

描述(由申请人提供)：世界人口正在发生历史性的转变，进入慢性身体疾病、精神障碍和残疾患病率增加的年龄段。慢性身体状况和精神障碍都是导致残疾的主要原因。可治疗的精神障碍和慢性身体疾病经常同时发生，但没有关于它们共同发病的国家数据。在广大人口中，患有严重慢性身体疾病的特定精神障碍患者的残疾程度和性质在很大程度上是未知的。越来越多的证据表明，治疗共病精神障碍可以改善慢性身体疾病患者的功能结果。不幸的是，应对日益流行的慢性病、精神障碍和相关残疾的努力没有可靠的人口数据作为指导。在应对这一挑战时，迫切需要流行病学数据来指导研究、临床实践、卫生保健组织和公共政策。 针对PA-02-047(共病精神和其他身体疾病研究)，我们的目标是通过确定患有严重慢性身体疾病的精神障碍患者的残疾程度和性质来解决这一知识差距。我们将使用参与世卫组织世界精神卫生(WMH)倡议的28项协调全国人口调查(N=19.6万)的数据。我们将研究情绪、焦虑、物质使用和冲动控制障碍如何影响患有心血管疾病、糖尿病、呼吸系统疾病、关节炎和慢性疼痛的人的残疾。这项研究计划的具体目标是：目标1：估计具有重大慢性身体障碍的典型病例中可治疗的精神障碍的患病率，这些疾病是导致残疾的主要原因；目标2：通过校准用于国家和国际健康调查和健康结果研究的WMH残疾衡量标准，改进残疾研究方法；目的3：确定精神障碍对主要慢性身体疾病患者中的全球和特定角色残疾(包括工作角色残疾)的具体贡献；以及目标4：确定身心并存和社会角色残疾对包括医疗设施、家庭负担和耻辱在内的疾病负担的更广泛衡量标准的影响。

DESCRIPTION (provided by applicant): An historic shift of the world population into age groups with increased prevalence of chronic physical diseases, mental disorders and disability is taking place. Chronic physical conditions and mental disorders are both leading causes of disability. Treatable mental disorders and chronic physical conditions often co-occur, but national data concerning their co-morbidity are not available. The extent and nature of disability among persons with specific mental disorders co-morbid with major chronic physical conditions is largely unknown in the population-at-large. There is growing evidence that treating co-morbid mental disorders improves functional outcomes among persons with chronic physical diseases. Unfortunately, efforts to respond to the growing epidemic of chronic disease, mental disorders and related disability are not guided by reliable population-based data. Epidemiological data are urgently needed to guide research, clinical practice, health care organization and public policy in responding to this challenge. In response to PA-02-047 (Research on Co-morbid Mental and Other Physical Disorders), our goal is to address this knowledge gap by determining the extent and nature of disability among persons with mental disorders that are co-morbid with major chronic physical conditions. We will employ data from 28 coordinated national population surveys (N=196,000) participating in the WHO World Mental Health (WMH) initiative. We will study how mood, anxiety, substance use and impulse control disorders influence disability among persons with cardiovascular disease, diabetes, respiratory disorders, arthritis,and chronic pain conditions. The specific aims of this program of research are: Aim 1: Estimate prevalence rates of treatable mental disorders among representative cases with major chronic physical disorders that are leading causes of disability; Aim 2: Advance disability research methods by calibrating WMH disability measures for use in national and international health surveys and health outcomes research; Aim3: Establish the specific contributions of mental disorders to global and specific role disabilities (including work role disability) among persons with major chronic physical disorders; and Aim 4: Determine the effects of physical-mental co-morbidity and social role disability on broader measures of disease burden including health utilities, family burden and stigma.