Frisher Martin, Crome Ilana, Macleod John, Millson David, Croft Peter
Department of Medicines Management, Keele University, Staffordshire ST5 5BG, UK.
J Epidemiol Community Health. 2005 Oct;59(10):847-50. doi: 10.1136/jech.2004.030833.
To quantify the relation between substance misuse and psychiatric illness in the UK general practice population in terms of (a) the relative risk of developing one condition given prior exposure to the other and (b) the proportion of cases of one condition attributable to exposure to the other.
Population based prospective observational study using the general practice research database (GPRD) between 1993 and 1998. The 230 GP practices represent 3.1% of the population.
England and Wales.
1.4 million registered patients of whom 3969 had both substance misuse and psychiatric diagnoses between 1993 and 1998.
Relative risk (RR) for subsequent psychiatric illness among participants exposed to substance misuse and RR for subsequent substance misuse among participants exposed to psychiatric illness. Population attributable risk (PAR) of psychiatric illness attributable to substance misuse and of substance misuse attributable to psychiatric illness.
The baseline prevalence of psychiatric illness over the study period was 15% and 0.3% for substance abuse. RR for psychiatric illness for substance misusers compared with non-substance misusers was 1.54 (95% CI 1.47 to 1.62). RR for substance misuse among psychiatric compared with non-psychiatric cases was 2.09 (95% CI 1.99 to 2.22). PAR for psychiatric illness attributable to substance misuse was 0.2%. PAR for substance misuse attributable to psychiatric illness was 14.2%.
Only a comparatively small proportion of psychiatric illness seems possibly attributable to substance use whereas a more substantial proportion of substance use seems possibly attributable to psychiatric illness. This study does not support the hypotheses that comorbidity between substance misuse and psychiatric illness is primarily the result of substance misuse or that increasing comorbidity is largely attributable to increasing substance misuse.
从以下两方面量化英国全科医疗人群中药物滥用与精神疾病之间的关系：（a）先前接触过一种疾病的情况下患另一种疾病的相对风险；（b）一种疾病的病例中可归因于接触另一种疾病的比例。
基于人群的前瞻性观察性研究，使用1993年至1998年的全科医疗研究数据库（GPRD）。230家全科医疗诊所代表了3.1%的人口。
英格兰和威尔士。
140万注册患者，其中3969人在1993年至1998年间既有药物滥用又有精神疾病诊断。
接触药物滥用的参与者中后续患精神疾病的相对风险（RR），以及接触精神疾病的参与者中后续药物滥用的RR。药物滥用所致精神疾病的人群归因风险（PAR），以及精神疾病所致药物滥用的PAR。
在研究期间，精神疾病的基线患病率为15%，药物滥用为0.3%。与非药物滥用者相比，药物滥用者患精神疾病的RR为1.54（95%CI 1.47至1.62）。与非精神疾病患者相比，精神疾病患者中药物滥用的RR为2.09（95%CI 1.99至2.22）。药物滥用所致精神疾病的PAR为0.2%。精神疾病所致药物滥用的PAR为14.2%。
似乎只有相对较小比例的精神疾病可能归因于药物使用，而较大比例的药物使用似乎可能归因于精神疾病。本研究不支持以下假设：药物滥用与精神疾病的共病主要是药物滥用的结果，或者共病增加在很大程度上归因于药物滥用的增加。
