de Graaf R, Bijl R V, Spijker J, Beekman A T F, Vollebergh W A M
Monitoring and Epidemiology Department, Netherlands Institute of Mental Health and Addiction, P. O. Box 725, 3500 AS Utrecht, The Netherlands.
Soc Psychiatry Psychiatr Epidemiol. 2003 Jan;38(1):1-11. doi: 10.1007/s00127-003-0597-4.
Little is known about the temporal sequencing of psychiatric disorders. The aim of this study was to obtain insight into patterns of co-occurrence of DSM-III-R mood disorders in relation to anxiety and substance use disorders, their temporal sequencing and the sociodemographic and long-term vulnerability predictors of this temporal sequencing.
Data are from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), a psychiatric epidemiological study in a representative sample of 7,076 adults aged 18-64.
Of those who had ever experienced a mood disorder, 46 % of males and 57 % of females had a history of anxiety disorders, and 43 % and 15 % of substance use disorders. Mood disorders were associated with all anxiety and substance use disorders, except with alcohol abuse among males. In the majority of anxiety-comorbid cases, the mood disorder arose after the anxiety disorder; the pattern for substance use-comorbid disorders was more variable. Deviation from the usual sequence of major depression and anxiety disorders was more often seen among females, subjects with a higher educational level, subjects who experienced childhood parental divorce, and subjects who experienced childhood emotional neglect.
When comorbid with anxiety disorders, mood disorders clearly tend to be secondary. Few of the studied demographic factors, familial vulnerability factors and childhood life events predict the sequencing of mood disorders in relation to other disorders.
关于精神障碍的时间顺序了解甚少。本研究的目的是深入了解《精神疾病诊断与统计手册》第三版修订本（DSM-III-R）中情绪障碍与焦虑和物质使用障碍共病的模式、它们的时间顺序以及这种时间顺序的社会人口统计学和长期易感性预测因素。
数据来自荷兰精神健康调查与发病率研究（NEMESIS），这是一项对7076名18 - 64岁成年人的代表性样本进行的精神疾病流行病学研究。
在曾经经历过情绪障碍的人群中，46%的男性和57%的女性有焦虑障碍病史，43%和15%有物质使用障碍病史。情绪障碍与所有焦虑和物质使用障碍相关，但男性中的酒精滥用除外。在大多数焦虑共病病例中，情绪障碍在焦虑障碍之后出现；物质使用共病障碍的模式则更具变异性。在女性、教育水平较高的受试者、童年时期父母离异的受试者以及童年时期经历过情感忽视的受试者中，更常出现与重度抑郁症和焦虑症通常顺序不同的情况。
当与焦虑障碍共病时，情绪障碍显然往往是继发性的。所研究的人口统计学因素、家族易感性因素和童年生活事件中，很少有因素能预测情绪障碍与其他障碍相关的时间顺序。
