Brugha T S, Morgan Z, Bebbington P, Jenkins R, Lewis G, Farrell M, Meltzer H
Department of Psychiatry, University of Leicester, Leicester General Hospital.
Psychol Med. 2003 Feb;33(2):307-18. doi: 10.1017/s0033291702006505.
Current knowledge about associations between psychosocial factors and non-psychotic symptoms provide little information about their relationship to specific types of neurotic symptoms such as symptoms of fatigue, worry, phobic anxiety and obsessional symptoms.
The British National Survey of Psychiatric Morbidity was based on a cross-sectional random sample of 10,108 householders. Neurotic symptoms were established by lay interviewers using the revised fully structured Clinical Interview Schedule (CIS-R). Subjects were asked about perceived social support, the size of their close primary social network and sociodemographic attributes. To assess possible associations between specific types of neurotic symptoms and psychosocial risk factors multivariate Huber logistic models (a modified form of repeated measures design modelling) was used taking account of correlation between symptom types and sampling design including clustering.
After controlling for sociodemographic factors the risk of having a high total CIS-R score (> or = 12) was approximately doubled for both types of poor social functioning. Specific types of neurotic symptoms were associated both with a small primary group and with inadequate perceived social support. Depression, depressive ideas and panic symptoms had a higher prevalence in multivariate models. Poverty was associated with low support.
Associations with deficiencies in social support and self-reported neurotic symptoms are better explained by symptom type and in particular by depression than by the total number of symptoms. If confirmed by longitudinal study findings this knowledge could be used to inform the development of interventions to improve social support in order to reduce specific neurotic symptom types.
目前关于社会心理因素与非精神病性症状之间关联的知识,几乎没有提供它们与特定类型神经症症状(如疲劳、担忧、恐惧焦虑和强迫症状)之间关系的信息。
英国国家精神病发病率调查基于对10108名住户的横断面随机抽样。神经症症状由非专业访谈者使用修订后的完全结构化临床访谈表(CIS-R)确定。询问受试者关于感知到的社会支持、其亲密主要社会网络的规模以及社会人口学特征。为了评估特定类型神经症症状与社会心理风险因素之间可能的关联,使用了多元休伯逻辑模型(重复测量设计建模的一种修改形式),同时考虑了症状类型之间的相关性以及包括聚类在内的抽样设计。
在控制了社会人口学因素后,两种类型的社会功能不良使CIS-R总分较高(≥12分)的风险增加了约一倍。特定类型的神经症症状既与较小的主要群体有关,也与感知到的社会支持不足有关。在多元模型中,抑郁、抑郁观念和惊恐症状的患病率更高。贫困与低支持有关。
与社会支持不足和自我报告的神经症症状之间的关联,用症状类型,特别是用抑郁来解释,比用症状总数来解释更好。如果纵向研究结果证实了这一点,这些知识可用于为改善社会支持以减少特定神经症症状类型的干预措施的制定提供信息。