Todd J, Green G, Harrison M, Ikuesan B A, Self C, Baldacchino A, Sherwood S
Department of Health and Human Sciences, University of Essex, Colchester, UK.
J Psychiatr Ment Health Nurs. 2004 Feb;11(1):48-54. doi: 10.1111/j.1365-2850.2004.00683.x.
This paper discusses methodological issues arising in the initial stages of a larger epidemiological case-control study. Practitioners from both Generic Mental Health and Substance Misuse Services (n = 170) were asked to identify which of their clients, from a time-limited caseload (n = 2341), had comorbid mental health and substance misuse problems. Although practitioners were provided with a definition of 'singly diagnosed' and 'dually diagnosed', it became apparent that these definitions were applied pragmatically, depending on the nature of the client's primary problem and the agency they were presenting to. Issues raised include the time period in which a client was considered to have a concurrent mental health problem and substance misuse, how a 'mental health problem' was defined and whether a personality disorder should be categorized as a 'mental health problem'. There was also some disagreement about whether clients who were being treated primarily by Substance Misuse Services, but were also taking prescribed antidepressants, implicitly had a 'mental health problem'. We raise these methodological issues, as they have implications for determining the prevalence of 'dual diagnosis' and the subsequent provision of services.
本文讨论了一项更大规模的流行病学病例对照研究初始阶段出现的方法学问题。来自普通精神健康和药物滥用服务机构的从业者（共170人）被要求从其在一定期限内的病例总量（共2341例）中确定哪些客户同时存在精神健康和药物滥用问题。尽管向从业者提供了“单一诊断”和“双重诊断”的定义，但很明显，这些定义是根据客户主要问题的性质以及他们就诊的机构来实际应用的。提出的问题包括客户被视为同时患有精神健康问题和药物滥用的时间段、“精神健康问题”如何定义以及人格障碍是否应归类为“精神健康问题”。对于主要接受药物滥用服务但也在服用处方抗抑郁药的客户是否隐含“精神健康问题”，也存在一些分歧。我们提出这些方法学问题，因为它们对确定“双重诊断”的患病率以及随后的服务提供有影响。
