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。 在过去的一年里，我们完成了全国共病调查的初步分析--复制数据。研究结果发表在6月号的《档案》上。 普通精神病学。这些论文有几个主要发现： 首先，正如早期基于人群的研究所报告的那样，精神障碍在生命早期就开始了 而且是常见的和持久的。正如世界卫生组织疾病负担研究(15)所指出的，精神疾病是年轻人的慢性病。Kessler等人在他们的样本中发现了46.4%的终生精神障碍史和26.2%的12个月患病率，其中一半的病例报告在14岁之前发病，四分之三的病例在24岁之前发病。 其次，Kessler等人报告称，在过去12个月内被诊断为精神障碍的人中，超过一半的人被评为严重(22.3%)或中等(37.3%)，而不是轻度。那些被评为严重的人(占人口的5.8%)报告说，他们由于精神或药物滥用问题而无法进行正常日常活动的平均时间为88.3天。收视率？严重吗？最常见的是双相情感障碍(83%)、药物依赖(56.5%)、强迫症(50.6%)、对立-违抗障碍(49.6%)和情绪障碍(45%)。证实了早期研究中描述的高共病发生率，45%的人口符合两种或两种以上疾病的标准，其严重程度与共病密切相关。 最后，美国的精神卫生保健状况不佳。在12个月的时间里，60%的障碍患者(回想一下，其中60%是严重或中度的)没有接受治疗。虽然这项调查只能粗略地估计对循证标准的遵守和治疗的充分性，但护理的来源是有信息的。那些有精神或物质使用障碍的人比精神病学家更有可能得到普通医疗专业人员(例如初级保健医生或护士)或补充替代来源(例如互联网支持小组)的帮助。然而，精神健康专科护理的治疗质量要高得多(48.0%的专科精神健康治疗最低限度够用，而普通医疗和非医疗保健的治疗质量分别为12.8%和13.1%)。 我们还分析了以下主题的数据和完成的手稿：偏头痛和其他头痛，双相情感障碍的谱系，情绪障碍的性别差异，精神和身体障碍对工作残疾的影响，以及睡眠和情绪障碍之间的共病。在接下来的一年里，我们计划完成这些手稿并继续分析数据。我们还将在未来6个月内准备好数据供公众查阅。

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 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 World Mental Health Survey Initiative. During the past year, we have completed the primary analyses of the National Comorbidity Survey-Replication data. The results were presented in the June issue of the Archives of General Psychiatry. There are several major findings from these papers: First, as reported in earlier population-based studies, mental disorders begin in early life and are common and protracted. As suggested in the W.H.O. Burden of Disease study (15), mental illnesses are the chronic diseases of the young. Kessler et al find lifetime history of a mental disorder in 46.4 % of their sample and a 12-month prevalence of 26.2%, with half of all cases reporting onset by age 14 and three-quarters by age 24. Secondly, Kessler et al report that more than half of those diagnosed with a disorder in the previous 12 months were rated as ?serious? (22.3%) or ?moderate? (37.3%) rather than mild. Those rated as ?serious? (5.8% of the population) reported a mean of 88.3 days when they were unable to carry out their normal daily activities because of mental or substance abuse problems. Ratings of ?serious? were most common among bipolar disorder (83%), drug dependence (56.5%), obsessive-compulsive disorder (50.6%), oppositional-defiant disorder (49.6%), and mood disorders (45%). Corroborating the high rates of comorbidity described in earlier studies, 45% of the population met criteria for two or more disorders, with severity strongly related to comorbidity. Finally, mental health care in America is ailing. Over a 12-month period, 60% of those with a disorder (recall that 60% of these are serious or moderate) receive no treatment. While the survey can only crudely estimate adherence to evidence-based standards and adequacy of treatment, the sources of care are informative. Those with a mental or substance use disorder were more likely to receive help from a general medical professional (e.g. primary care physician or nurse) or a complementary-alternative source (e.g. internet support group) than a psychiatrist. Yet, quality of treatment is much higher in mental health specialty care (minimally adequate in 48.0% of specialty mental health vs. 12.8% of general medical and 13.1% for non-healthcare). We have also analyzed data and completed manuscripts on the following topics: migraine and other headaches, the spectrum of bipolar disorder, sex differences in mood disorders, the impact of mental and physical disorders on work disability, and comorbidity between sleep and mood disorders. During the next year, we plan to complete these manuscripts and continue to analyze the data. We will also prepare the data for public access within the next 6 months.