Vos T, Mathers C, Herrman H, Harvey C, Gureje O, Bui D, Watson N, Begg S
Public Health Division, Department of Human Services, 18-120 Spencer Street, Melbourne, Victoria 3000, Australia.
Soc Psychiatry Psychiatr Epidemiol. 2001 Feb;36(2):53-62. doi: 10.1007/s001270050290.
Between 1998 and 1999, a burden of disease assessment was carried out in Victoria, Australia applying and improving on the methods of the Global Burden of Disease Study. This paper describes the methods and results of the calculations of the burden due to 22 mental disorders, adding 14 conditions not included in previous burden of disease estimates.
The National Survey of Mental Health and Wellbeing provided recent data on the occurrence of the major adult mental disorders in Australia. Data from international studies and expert advice further contributed to the construction of disease models, describing each condition in terms of incidence, average duration and level of severity, with adjustments for comorbidity with other mental disorders. Disability weights for the time spent in different states of mental ill health were borrowed mainly from a study in the Netherlands, supplemented by weights derived in a local extrapolation exercise.
Mental disorders were the third largest group of conditions contributing to the burden of disease in Victoria, ranking behind cancers and cardiovascular diseases. Depression was the greatest cause of disability in both men and women. Eight other mental disorders in men and seven in women ranked among the top twenty causes of disability.
Insufficient information on the natural history of many of the mental disorders, the limited information on the validity of mental disorder diagnoses in community surveys and considerable differences between ICD-10 and DSM-IV defined diagnoses were the main concerns about the accuracy of the estimates. Similar and often greater concerns have been raised in relation to the estimation of the burden from common non-fatal physical conditions such as asthma, diabetes and osteoarthritis. In comparison, psychiatric epidemiology can boast greater scientific rigour in setting standards for population surveys.
1998年至1999年期间，澳大利亚维多利亚州开展了一项疾病负担评估，采用并改进了全球疾病负担研究的方法。本文描述了22种精神障碍所致疾病负担的计算方法和结果，新增了14种先前疾病负担估计未涵盖的病症。
全国心理健康与幸福调查提供了澳大利亚主要成人精神障碍发病情况的近期数据。国际研究数据和专家意见进一步助力构建疾病模型，从发病率、平均病程和严重程度方面描述每种病症，并对与其他精神障碍的共病情况进行调整。不同精神疾病健康状态下的失能权重主要借鉴荷兰的一项研究，并辅以本地推断得出的权重。
精神障碍是维多利亚州疾病负担的第三大病因组，仅次于癌症和心血管疾病。抑郁症是男性和女性残疾的最大原因。男性的其他八种精神障碍和女性的七种精神障碍位列残疾的前二十个主要原因。
许多精神障碍自然史信息不足、社区调查中精神障碍诊断有效性的信息有限，以及国际疾病分类第10版（ICD - 10）和精神疾病诊断与统计手册第四版（DSM - IV）定义的诊断之间存在相当大的差异，是对估计准确性的主要担忧。对于哮喘、糖尿病和骨关节炎等常见非致命身体疾病的负担估计，也提出了类似且往往更大的担忧。相比之下，精神疾病流行病学在设定人群调查标准方面具有更高的科学严谨性。
