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的患病率和相关性的数据。这项研究的设计是对来自48个毗邻的美国的18岁及以上成年人进行的可能性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)重新访问了基线的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。同时，在全国范围内对10,000名受访者进行了NCS复制调查(NCS-R)。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。在世界卫生组织世界精神卫生调查倡议的主持下，国家预防犯罪数据分析小组正在对这些调查进行集中的跨国分析。 NCS-R实地研究于2003年秋季完成。经过一年半的数据处理、诊断算法的开发和复杂的加权程序，NCS-A的首批流行率论文于2005年6月发表。我们一直在参与我们研究的主要主题的工作，包括情绪障碍和精神和身体共病。 与我们的研究相关的这项工作的主要发现是，在人群中存在双相情感障碍的表现谱，证据表明阈值下双相情感障碍的临床有效性；双相情感障碍和其他精神障碍之间的共患率显著上升，以至于近三分之二的双相情感障碍患有药物使用障碍；使用一种新的分析方法来解释共病，我们估计了普通心理和身体状况对普通人群中角色残疾的比较影响。在控制了共病后，我们发现，在人口层面上，精神疾病导致的残疾天数是所有身体疾病的一半以上；在一般人群中，85%的偏头痛患者至少有一种终生精神或身体疾病。共病可以解释一半以上与偏头痛相关的角色残疾。情绪障碍的表现是多种多样的，因此那些患有轻度障碍的人在十年的随访中复发的可能性很高。

The key objective of this study is to collect the first nationally representative data on prevalences 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 were 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) was 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 World Mental Health Survey Initiative. The NCS-R field study was completed in the fall of 2003. After one and one-half years of data processing, development of diagnostic algorithms and complex weighting procedures, the first prevalence papers from the NCS-A were published in June of 2005 . We have been involved in the work on the major themes of our research including mood disorders and mental and physical comorbidity. The major findings of this work that are relevant to our research are that there is a spectrum of expression of bipolar disorder in the population with evidence for clinical validity of sub-threshold bipolar disorder; comorbidity between bipolar disorder and other mental disorders is dramatically elevated such that nearly two-thirds of bipolars have a substance use disorder; using a novel analytic method that accounts for comorbidity, we estimated the comparative effects of common mental and physical conditions on role disability in the general population. After controlling for comorbidity, we found that mental conditions account for more than half as many disability days as all physical conditions at the population level; eighty-five percent of migraineurs in the general population have at least one other lifetime mental or physical disorder. Comorbidity explained more than half the role disability associated with migraine. There is a spectrum of expression of mood disorders such that those with mild disorders have a high probability of recurrence across a decade of follow up.