National Comorbidity Survey - Replication (NCS-R)

本研究的主要目的是从最近完成的全国科摩罗重复调查（NCS-R）中收集关于DSM-IV MDD患病率和相关性的第一个全国代表性数据。这项研究的设计是一个直接访谈家庭调查的概率家庭调查的成年人年龄在18岁及以上，从48个连续的美国。研究中的受试者总数为9090例，代表79%的缓解率。诊断访谈是WHO复合国际诊断访谈（CIDI），旨在收集DSM-IV的诊断标准。采用DSM-IV（SCID）结构化临床访谈进行临床再访谈，以验证CIDI诊断。 NCS研究计划包括与美国国家科摩罗调查（NCS）相关的一系列调查。从1990年秋季到1992年春季进行的基线NCS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疾病的患病率和相关性。基线NCS受访者在2001-02年（NCS-2）进行了重新访谈，以研究精神和物质使用障碍的模式和预测因素，并评估原发性精神障碍在预测继发性物质障碍的发病和病程中的作用。与此同时，在新的全国10，000名受访者样本中进行了NCS复制调查（NCS-R）。NCS-R的目标是研究基线NCS中评估的广泛变量的趋势，并获得有关基线NCS中未涵盖或涵盖深度低于我们目前期望的一些主题的更多信息。在进行国家统计调查-R和国家统计调查-2的同时，还对10，000名青少年进行了调查（国家统计调查-A）。NCS-A的目标是编制关于青年精神障碍的流行率和相关因素的全国代表性数据。最后，国家能力状况评估-R和国家能力状况评估-A正在世界各地的一些国家得到推广。在世界卫生组织世界精神卫生调查倡议的主持下，国家统计局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的第一篇患病率论文于2005年6月发表。我们一直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达谱，有证据表明亚阈值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病率显著升高，以至于近三分之二的双相情感障碍患者患有物质使用障碍;我们使用一种新的分析方法来解释共病，估计了普通人群中常见的精神和身体状况对角色残疾的比较影响。在控制了合并症后，我们发现在人群水平上，精神疾病占所有身体疾病残疾天数的一半以上;一般人群中85%的偏头痛患者一生中至少有一种其他精神或身体疾病。 科摩罗解释了与偏头痛相关的一半以上的角色残疾。情绪障碍有一系列的表现，因此那些轻度障碍的患者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 a 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.