Glantz M D, Anthony J C, Berglund P A, Degenhardt L, Dierker L, Kalaydjian A, Merikangas K R, Ruscio A M, Swendsen J, Kessler R C
Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse, National Institutes of Health, 6001 Executive Boulevard, Bethesda, MD 20892, USA.
Psychol Med. 2009 Aug;39(8):1365-77. doi: 10.1017/S0033291708004510. Epub 2008 Dec 2.
Although mental disorders have been shown to predict subsequent substance disorders, it is not known whether substance disorders could be cost-effectively prevented by large-scale interventions aimed at prior mental disorders. Although experimental intervention is the only way to resolve this uncertainty, a logically prior question is whether the associations of mental disorders with subsequent substance disorders are strong enough to justify mounting such an intervention. We investigated this question in this study using simulations to estimate the number of substance disorders that might be prevented under several hypothetical intervention scenarios focused on mental disorders.
Data came from the National Comorbidity Survey Replication (NCS-R), a nationally representative US household survey that retrospectively assessed lifetime history and age of onset of DSM-IV mental and substance disorders. Survival analysis using retrospective age-of-onset reports was used to estimate associations of mental disorders with subsequent substance dependence. Simulations based on the models estimated effect sizes in several hypothetical intervention scenarios.
Although successful intervention aimed at mental disorders might prevent some proportion of substance dependence, the number of cases of mental disorder that would have to be treated to prevent a single case of substance dependence is estimated to be so high that this would not be a cost-effective way to prevent substance dependence (in the range 76-177 for anxiety-mood disorders and 40-47 for externalizing disorders).
Treatment of prior mental disorders would not be a cost-effective way to prevent substance dependence. However, prevention of substance dependence might be considered an important secondary outcome of interventions for early-onset mental disorders.
尽管已有研究表明精神障碍可预测随后发生的物质使用障碍，但尚不清楚针对既往精神障碍进行大规模干预能否以具有成本效益的方式预防物质使用障碍。虽然实验性干预是解决这一不确定性的唯一方法，但一个逻辑上更为优先的问题是，精神障碍与随后发生的物质使用障碍之间的关联是否足够强大，足以证明开展此类干预的合理性。在本研究中，我们通过模拟来估计在几种针对精神障碍的假设干预情景下可能预防的物质使用障碍病例数，以此对这一问题进行了调查。
数据来自全国共病调查复制研究（NCS-R），这是一项具有全国代表性的美国家庭调查，该调查回顾性评估了DSM-IV精神障碍和物质使用障碍的终生病史及发病年龄。使用基于回顾性发病年龄报告的生存分析来估计精神障碍与随后发生的物质依赖之间的关联。基于这些模型的模拟估计了几种假设干预情景下的效应大小。
尽管针对精神障碍的成功干预可能会预防一定比例的物质依赖，但据估计，为预防一例物质依赖而必须治疗的精神障碍病例数非常高，以至于这不是预防物质依赖的一种具有成本效益的方式（焦虑-情绪障碍的范围为76-177，外化性障碍的范围为40-47）。
治疗既往精神障碍并非预防物质依赖的一种具有成本效益的方式。然而，预防物质依赖可被视为早发性精神障碍干预措施的一个重要次要结果。
