Merikangas Kathleen R, Jin Robert, He Jian-Ping, Kessler Ronald C, Lee Sing, Sampson Nancy A, Viana Maria Carmen, Andrade Laura Helena, Hu Chiyi, Karam Elie G, Ladea Maria, Medina-Mora Maria Elena, Ono Yutaka, Posada-Villa Jose, Sagar Rajesh, Wells J Elisabeth, Zarkov Zahari
National Institute of Mental Health, Bethesda, MD 20892, USA.
Arch Gen Psychiatry. 2011 Mar;68(3):241-51. doi: 10.1001/archgenpsychiatry.2011.12.
There is limited information on the prevalence and correlates of bipolar spectrum disorder in international population-based studies using common methods.
To describe the prevalence, impact, patterns of comorbidity, and patterns of service utilization for bipolar spectrum disorder (BPS) in the World Health Organization World Mental Health Survey Initiative.
DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional, face-to-face, household surveys of 61,392 community adults in 11 countries in the Americas, Europe, and Asia assessed with the World Mental Health version of the World Health Organization Composite International Diagnostic Interview, version 3.0, a fully structured, lay-administered psychiatric diagnostic interview.
Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) disorders, severity, and treatment.
The aggregate lifetime prevalences were 0.6% for bipolar type I disorder (BP-I), 0.4% for BP-II, 1.4% for subthreshold BP, and 2.4% for BPS. Twelve-month prevalences were 0.4% for BP-I, 0.3% for BP-II, 0.8% for subthreshold BP, and 1.5% for BPS. Severity of both manic and depressive symptoms as well as suicidal behavior increased monotonically from subthreshold BP to BP-I. By contrast, role impairment was similar across BP subtypes. Symptom severity was greater for depressive episodes than manic episodes, with approximately 74.0% of respondents with depression and 50.9% of respondents with mania reporting severe role impairment. Three-quarters of those with BPS met criteria for at least 1 other disorder, with anxiety disorders (particularly panic attacks) being the most common comorbid condition. Less than half of those with lifetime BPS received mental health treatment, particularly in low-income countries, where only 25.2% reported contact with the mental health system.
Despite cross-site variation in the prevalence rates of BPS, the severity, impact, and patterns of comorbidity were remarkably similar internationally. The uniform increases in clinical correlates, suicidal behavior, and comorbidity across each diagnostic category provide evidence for the validity of the concept of BPS. Treatment needs for BPS are often unmet, particularly in low-income countries.
在采用通用方法的国际人群研究中，关于双相谱系障碍的患病率及其相关因素的信息有限。
描述世界卫生组织世界心理健康调查倡议中双相谱系障碍（BPS）的患病率、影响、共病模式及服务利用模式。
设计、地点和参与者：对美洲、欧洲和亚洲11个国家的61392名社区成年人进行横断面面对面家庭调查，采用世界卫生组织复合国际诊断访谈的世界心理健康版（第3.0版）进行评估，这是一种完全结构化、由非专业人员实施的精神科诊断访谈。
《精神障碍诊断与统计手册》（第四版）中的疾病、严重程度及治疗情况。
双相I型障碍（BP-I）的终生患病率总计为0.6%，双相II型障碍（BP-II）为0.4%，阈下双相障碍为1.4%，双相谱系障碍为2.4%。12个月患病率方面，BP-I为0.4%，BP-II为0.3%，阈下双相障碍为0.8%，双相谱系障碍为1.5%。从阈下双相障碍到BP-I，躁狂和抑郁症状的严重程度以及自杀行为均呈单调增加。相比之下，各双相亚型的角色功能损害情况相似。抑郁发作的症状严重程度高于躁狂发作，约74.0%的抑郁患者和50.9%的躁狂患者报告有严重的角色功能损害。四分之三的双相谱系障碍患者符合至少一种其他疾病的标准，焦虑障碍（尤其是惊恐发作）是最常见的共病情况。终生患有双相谱系障碍的患者中，不到一半接受过心理健康治疗，在低收入国家尤其如此，只有25.2%的患者报告与心理健康系统有过接触。
尽管双相谱系障碍的患病率在不同地点存在差异，但其严重程度、影响及共病模式在国际上显著相似。各诊断类别中临床相关因素、自杀行为及共病情况的一致增加为双相谱系障碍概念的有效性提供了证据。双相谱系障碍的治疗需求常常未得到满足，在低收入国家尤其如此。
