辽宁省成人精神障碍流行病学调查
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摘要
目的了解辽宁省城乡居民各类精神障碍现患率及分布特点,为制定辽宁省精神卫生规划提供客观依据。方法 2014年10月—2015年6月,采用多阶段分层整群随机抽样方法 ,在辽宁省7个地级市随机抽取24000人为研究对象,应用增补后的一般健康问卷(GHQ-12)进行筛查,分为精神障碍高、中、低危险3组,由精神科医生用美国精神障碍诊断与统计手册(DSM-IV)轴I障碍临床定式检查(SCID-I/P)依次对100%、40%和10%的3组调查对象进行诊断检查。结果有效调查19733人(82.22%),其中精神障碍的总现患率(最近一个月)为14.05%,女性12.93%,男性15.47%;城市人群13.04%,农村人群14.83%;30~50岁及>60岁年龄段是多种精神障碍的高发年龄;心境障碍(4.57%)、焦虑障碍(3.63%)、物质使用障碍(2.29%)是3个最常见的疾病诊断组,酒精使用障碍(2.29%)、抑郁障碍(2.28%)是患病率最高的2种精神障碍。结论辽宁省精神障碍的现患率较高,精神问题已经成为关注的公共精神问题。
Objective To describe current prevalence and distribution of all types of mental disorders among adult residents in Liaoning province and to provide evidences for developing a provincial mental health plan. Methods Stratified multistage cluster randomization was used to recruit 24 000 urban and rural residents aged 18 years and above in 7 municipalities. All the participants were screened with the expanded version of the General Health Questionnaire( GHQ-12)and assigned into one of the three groups at high,moderate, and low risk of having a mental disorder. Then,based on the criterion of Diagnostic and Statistical Manual of Mental Disorders-4 th Edition( DSM-IV), the diagnostic examination was performed by psychiatrists among 100%, 40%, and 10% of the participants of the groups with high,moderate, and low risk of having a mental disorder using Structured Clinical Interview for DSM-IV Axis I Disorders-Patient Edition( SCIDI/P). The survey was carried out between October 2014 and June 2015. Results Of the residents, 82. 22%( 19 733)completed the survey. The adjusted current( in the previous one month) prevalence rate of any mental disorder was 14. 05%( 95% confidence interval: 13. 57%-15. 47%). The overall prevalence rate of mental disorders was higher in the males( 15. 46%) than in the females( 12. 93%), and slightly higher in rural participants( 14. 83%) than in urban participants( 13. 04%). Among all the participants, the three most common mental disorders were affective disorder( 4. 57%), anxiety disorder( 3. 63%), and substance use disorder( 2. 88%). Alcohol use disorder( 2. 86%) and major depression disorder( 2. 39%) were the most prevalent specific mental disorders. Conclusion The current prevalence rate of mental disorders is relatively high among adult residents and mental disorder has become a major public health problem in Liaoning province.
Objective To describe current prevalence and distribution of all types of mental disorders among adult residents in Liaoning province and to provide evidences for developing a provincial mental health plan. Methods Stratified multistage cluster randomization was used to recruit 24 000 urban and rural residents aged 18 years and above in 7 municipalities. All the participants were screened with the expanded version of the General Health Questionnaire( GHQ-12)and assigned into one of the three groups at high,moderate, and low risk of having a mental disorder. Then,based on the criterion of Diagnostic and Statistical Manual of Mental Disorders-4 th Edition( DSM-IV), the diagnostic examination was performed by psychiatrists among 100%, 40%, and 10% of the participants of the groups with high,moderate, and low risk of having a mental disorder using Structured Clinical Interview for DSM-IV Axis I Disorders-Patient Edition( SCIDI/P). The survey was carried out between October 2014 and June 2015. Results Of the residents, 82. 22%( 19 733)completed the survey. The adjusted current( in the previous one month) prevalence rate of any mental disorder was 14. 05%( 95% confidence interval: 13. 57%-15. 47%). The overall prevalence rate of mental disorders was higher in the males( 15. 46%) than in the females( 12. 93%), and slightly higher in rural participants( 14. 83%) than in urban participants( 13. 04%). Among all the participants, the three most common mental disorders were affective disorder( 4. 57%), anxiety disorder( 3. 63%), and substance use disorder( 2. 88%). Alcohol use disorder( 2. 86%) and major depression disorder( 2. 39%) were the most prevalent specific mental disorders. Conclusion The current prevalence rate of mental disorders is relatively high among adult residents and mental disorder has become a major public health problem in Liaoning province.
引文
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[12]张杨,崔利军,栗克清,等.增补后的一般健康问卷在精神疾病流行病学调查中的应用[J].中国心理卫生杂志,2008,22(3):189-192.
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[16]罗国刚,韩建峰,屈秋民,等.简易精神状态检查适用人群及影响因素[J].中国心理卫生杂志,2002,16(4):246-249.
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[19]石其昌,章健民,徐方忠,等.浙江省15岁及以上人群精神疾病流行病学调查[J].中华预防医学杂志,2005,39(4):229-236.
[20]丁志杰,王刚平,汪东明.等.甘肃省天水市18岁及以上人群精神障碍流行病学调查[J].中国心理卫生杂志,2010,24(3):183-189.
[21]张敬悬,卢传华,唐济生,等.山东省18岁及以上人群精神障碍流行病学调查[J].精神医学杂志,2012,25(3):168-171.
[22]宋志强,杜欣柏,安海生,等.青海省18岁及以上人群精神障碍流行病学调查[J].中国心理卫生杂志,2010,24(3):168-175.
[23]辽宁省卫生与计划生育委员会.关于开展辽宁省精神疾病流行病学调查工作的通知[Z].沈阳:辽宁省卫生与计划生育委员会,2014.
[24]李献云,王志青,费立鹏.社区人群精神障碍患病率调查方法[J].中国心理卫生杂,2010.24(3):191-194.
[25]俞顺章.流行病学方法介绍-率的标化(调整).上海预防医学杂志,2007.19(5):212-214.
[26]张毅宏,胡纪泽,胡赤怡,等.深圳市神经症流行病学调查[J].中国公共卫生,2006,22(7):866-867.
[27]陈贺龙,胡斌,陈宪生,等.2002年江西省精神疾病患病率调查[J].中华精神科杂志,2004,37(3):172-175.
[28]陈强,韦波,冯启明,等.广西壮族自治区城市居民精神疾病流行病学调查[J].中国神经精神疾病杂志,2010,36(8):458-462.
[29]12地区精神疾病流行学调查协作组.国内12地区精神疾病流行学调查的方法学及资料分析[J].中华神经精神科杂志,1986,19:65-69.
[30]张维熙,沈渔邨,李淑然,等.中国七个地区精神疾病流行病学调查[J].中华精神科杂志,1998,31:229-236.
[31]黄悦勤.我国精神障碍流行病学研究现状[J].中国预防医学杂志,2008,9(5):445-446.
[32]Huang YQ,Liu ZR,Wang H,et al.The China Mental Health Survey(CM HS):I.Background,aims and measures[J].Soc Psychiatry Psychiatr Epidemiol,2016 online.Doi:10.1007/s00127-016-1270-z.
[33]杨晓丽,姜潮,富增国,等.辽宁省居民酒精使用障碍及影响因素分析[J].中国公共卫生,2011,27(7):935-937.
[34]韦波,陈强,冯启明,等.广西壮族自治区居民精神分裂症流行病学调查[J].中国公共卫生,2011,27(10):1245-1247.
[35]刘冬梅,王志青,杨永和,等.宜宾地区居民精神分裂症流行病学调查[J].中国公共卫生,2013,29(12):1755-1757.
[36]The WHO World Mental Health Survey Consortium.Prevalence,severity,and unmet need for treatment of mental disorders in the World Health Organization World M ental Health Surveys[J].JAMA,2004,291(21):2581-2590.
[37]Sharifi V,Amin-Esmaeili M,Hajebi A,et al.Twelve-month prevalence and correlates of psychiatric disorders in Iran:The Iranian M ental Health Surve[J].Arch Iran M ed,2015,18(2):76-84..
[38]Cho MJ,Su JS,Park JE,et al.Prevalence and correlates of DSM-IV mental disorders in South Korean adults:Te Korean Epidemiologic Catchment Area Study 2011[J].Psychiatry Investig,2015,12(2):164-170.
[39]Williams DR,Herman A,Stein DJ,et al.Twelve-month mental disorders in South Africa:prevalence,service use and demographic correlates in the population-based South African Stress and Health Study[J].Psychol M ed,2008,38(2):211-220.
[40]黄悦勤.我国精神卫生的现状与挑战[J].中国卫生政策研究,2011,4(9):5-9.
[2]World Health Organization.Mental health:new understanding,new hope[R].Geneva:World Health Organization,2001.
[3]Phillips MR.Mental health problem in China:challenge and choice in 21st century[J].Chin J Nerv Dis,2004,30(1):1-10.
[4]翟金国,赵靖平,陈敏,等.精神障碍的疾病负担[J].中国医药指南,2012,10(21):60-63.
[5]潘国伟,姜潮,杨晓丽,等.辽宁省城乡居民精神疾病流行病学调查[J].中国公共卫生,2006,22(12):1505-1507.
[6]辽宁省统计局.辽宁省统计年鉴[R].北京:中国统计出版社,2014.
[7]付鹏钰,胡东生,顾东风.多阶段整群随机抽样方法在流行病学研究中的运用[J].中国卫生统计,2010,27(3):299-300.
[8]刘明法,张立君,王铜,等.地方病调查中随机数字表的应用[J].中国地方病学杂志,2009,28(3):351-352.
[9]Goldherg DP,Gater R,Sartorius N,et al.The validity of two versions of the GHQ in the WHO study of mental illness in general health care[J].Psychol M ed,1997,27(1):191-197.
[10]Phillips MR,Zhang JX,Shi QC,et al.Prevalence,treatment and associated disability of mental disorders in four provinces in China during 2001-05:and epidemiological survey[J].Lancet,2009,373(9680):2041-2053.
[11]章健民,石其昌,徐方中,等.12项一般健康问卷假阳性和假阴性率及其相关因素[J].中国心理卫生杂志,2010,24(2):116-118.
[12]张杨,崔利军,栗克清,等.增补后的一般健康问卷在精神疾病流行病学调查中的应用[J].中国心理卫生杂志,2008,22(3):189-192.
[13]张明园.精神科评定量表手册[M].2版.长沙:湖南科学技术出版社,1998:561.
[14]李涛,周茹英,胡峻梅,等.DSM-IV-TR轴I障碍定式临床检查病人版(SCID-I/P)[M].中文版.成都:四川大学华西医院心理卫生研究所,2004.
[15]段晓宇,江新梅.HDS、MMSE、BBS在痴呆筛查中的应用[J].中风与神经疾病杂志,2002,19(3):167-168.
[16]罗国刚,韩建峰,屈秋民,等.简易精神状态检查适用人群及影响因素[J].中国心理卫生杂志,2002,16(4):246-249.
[17]American Psychiatric Association.Diagnostic and Statistical M anual of M ental Disorders(Fourth edition.DSM-IV)[M].Washington,DC:American Psychiatric Association,1994:1-886.
[18]栗克清,崔泽,崔利军,等.河北省精神障碍的现况调查[J].中华精神科杂志,2007,40(1):36-40.
[19]石其昌,章健民,徐方忠,等.浙江省15岁及以上人群精神疾病流行病学调查[J].中华预防医学杂志,2005,39(4):229-236.
[20]丁志杰,王刚平,汪东明.等.甘肃省天水市18岁及以上人群精神障碍流行病学调查[J].中国心理卫生杂志,2010,24(3):183-189.
[21]张敬悬,卢传华,唐济生,等.山东省18岁及以上人群精神障碍流行病学调查[J].精神医学杂志,2012,25(3):168-171.
[22]宋志强,杜欣柏,安海生,等.青海省18岁及以上人群精神障碍流行病学调查[J].中国心理卫生杂志,2010,24(3):168-175.
[23]辽宁省卫生与计划生育委员会.关于开展辽宁省精神疾病流行病学调查工作的通知[Z].沈阳:辽宁省卫生与计划生育委员会,2014.
[24]李献云,王志青,费立鹏.社区人群精神障碍患病率调查方法[J].中国心理卫生杂,2010.24(3):191-194.
[25]俞顺章.流行病学方法介绍-率的标化(调整).上海预防医学杂志,2007.19(5):212-214.
[26]张毅宏,胡纪泽,胡赤怡,等.深圳市神经症流行病学调查[J].中国公共卫生,2006,22(7):866-867.
[27]陈贺龙,胡斌,陈宪生,等.2002年江西省精神疾病患病率调查[J].中华精神科杂志,2004,37(3):172-175.
[28]陈强,韦波,冯启明,等.广西壮族自治区城市居民精神疾病流行病学调查[J].中国神经精神疾病杂志,2010,36(8):458-462.
[29]12地区精神疾病流行学调查协作组.国内12地区精神疾病流行学调查的方法学及资料分析[J].中华神经精神科杂志,1986,19:65-69.
[30]张维熙,沈渔邨,李淑然,等.中国七个地区精神疾病流行病学调查[J].中华精神科杂志,1998,31:229-236.
[31]黄悦勤.我国精神障碍流行病学研究现状[J].中国预防医学杂志,2008,9(5):445-446.
[32]Huang YQ,Liu ZR,Wang H,et al.The China Mental Health Survey(CM HS):I.Background,aims and measures[J].Soc Psychiatry Psychiatr Epidemiol,2016 online.Doi:10.1007/s00127-016-1270-z.
[33]杨晓丽,姜潮,富增国,等.辽宁省居民酒精使用障碍及影响因素分析[J].中国公共卫生,2011,27(7):935-937.
[34]韦波,陈强,冯启明,等.广西壮族自治区居民精神分裂症流行病学调查[J].中国公共卫生,2011,27(10):1245-1247.
[35]刘冬梅,王志青,杨永和,等.宜宾地区居民精神分裂症流行病学调查[J].中国公共卫生,2013,29(12):1755-1757.
[36]The WHO World Mental Health Survey Consortium.Prevalence,severity,and unmet need for treatment of mental disorders in the World Health Organization World M ental Health Surveys[J].JAMA,2004,291(21):2581-2590.
[37]Sharifi V,Amin-Esmaeili M,Hajebi A,et al.Twelve-month prevalence and correlates of psychiatric disorders in Iran:The Iranian M ental Health Surve[J].Arch Iran M ed,2015,18(2):76-84..
[38]Cho MJ,Su JS,Park JE,et al.Prevalence and correlates of DSM-IV mental disorders in South Korean adults:Te Korean Epidemiologic Catchment Area Study 2011[J].Psychiatry Investig,2015,12(2):164-170.
[39]Williams DR,Herman A,Stein DJ,et al.Twelve-month mental disorders in South Africa:prevalence,service use and demographic correlates in the population-based South African Stress and Health Study[J].Psychol M ed,2008,38(2):211-220.
[40]黄悦勤.我国精神卫生的现状与挑战[J].中国卫生政策研究,2011,4(9):5-9.