精神障碍作为风险因素：评估全球疾病负担研究的证据。
Mental disorders as risk factors: assessing the evidence for the Global Burden of Disease Study.
机构信息
Queensland Centre for Mental Health Research, The Park-Centre for Mental Health, Wacol, QLD 4076, Australia.
出版信息
BMC Med. 2011 Dec 16;9:134. doi: 10.1186/1741-7015-9-134.
BACKGROUND
Mental disorders are associated with a considerable burden of disease as well as being risk factors for other health outcomes. The new Global Burden of Disease (GBD) Study will make estimates for both the disability and mortality directly associated with mental disorders, as well as the burden attributable to other health outcomes. Herein we discuss the process by which health outcomes in which mental disorders are risk factors are selected for inclusion in the GBD Study. We make suggestions for future research to strengthen the body of evidence for mental disorders as risk factors.
METHODS
We identified a list of potential associations between mental disorders and subsequent health outcomes based on a review of the literature and consultation with mental health experts. A two-stage filter was applied to identify mental disorders and health outcomes that meet the criteria for inclusion in the GBD Study. Major limitations in the current literature are discussed and illustrated with examples identified during our review.
RESULTS AND DISCUSSION
Only two associations are included in the new GBD Study. These associations are the increased risk of ischemic heart disease with major depression and mental disorders as a risk factor for suicide. There is evidence that mental disorders are independent risk factors for cardiovascular disease (CVD), type 2 diabetes and injuries. However, these associations were unable to be included because of insufficient data. The most common reasons for exclusion were inconsistent identification of 'cases', uncertain validity of health outcomes, lack of generalizability, insufficient control for confounding factors and lack of evidence for temporality.
CONCLUSIONS
CVD, type 2 diabetes and injury are important public health policy areas. Prospective community studies of outcomes in patients with mental disorders are required, and their design must address a range of confounding factors.
背景
精神障碍与相当大的疾病负担有关，也是其他健康结果的风险因素。新的全球疾病负担（GBD）研究将对直接与精神障碍相关的残疾和死亡率以及归因于其他健康结果的负担进行估计。在此，我们讨论了将精神障碍作为风险因素的健康结果选择纳入 GBD 研究的过程。我们对未来的研究提出了建议，以加强精神障碍作为风险因素的证据基础。
方法
我们根据文献回顾和精神健康专家咨询，确定了一份精神障碍与随后健康结果之间潜在关联的清单。应用两阶段筛选方法来确定符合 GBD 研究纳入标准的精神障碍和健康结果。讨论了当前文献中的主要局限性，并通过我们审查中确定的示例进行了说明。
结果与讨论
只有两项关联被纳入新的 GBD 研究。这些关联是重度抑郁症患者中缺血性心脏病风险增加，以及精神障碍作为自杀的风险因素。有证据表明，精神障碍是心血管疾病（CVD）、2 型糖尿病和损伤的独立风险因素。然而，由于数据不足，这些关联无法被纳入。最常见的排除原因是“病例”的识别不一致、健康结果的有效性不确定、缺乏普遍性、对混杂因素的控制不足以及缺乏时间性证据。
结论
CVD、2 型糖尿病和损伤是重要的公共卫生政策领域。需要对患有精神障碍的患者的结局进行前瞻性社区研究，并且其设计必须解决一系列混杂因素。
Zotero 插件