Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
Int J Methods Psychiatr Res. 2012 Sep;21(3):169-84. doi: 10.1002/mpr.1359. Epub 2012 Aug 1.
Estimates of 12-month and lifetime prevalence and of lifetime morbid risk (LMR) of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) anxiety and mood disorders are presented based on US epidemiological surveys among people aged 13+. The presentation is designed for use in the upcoming DSM-5 manual to provide more coherent estimates than would otherwise be available. Prevalence estimates are presented for the age groups proposed by DSM-5 workgroups as the most useful to consider for policy planning purposes. The LMR/12-month prevalence estimates ranked by frequency are as follows: major depressive episode: 29.9%/8.6%; specific phobia: 18.4/12.1%; social phobia: 13.0/7.4%; post-traumatic stress disorder: 10.1/3.7%; generalized anxiety disorder: 9.0/2.0%; separation anxiety disorder: 8.7/1.2%; panic disorder: 6.8%/2.4%; bipolar disorder: 4.1/1.8%; agoraphobia: 3.7/1.7%; obsessive-compulsive disorder: 2.7/1.2. Four broad patterns of results are most noteworthy: first, that the most common (lifetime prevalence/morbid risk) lifetime anxiety-mood disorders in the United States are major depression (16.6/29.9%), specific phobia (15.6/18.4%), and social phobia (10.7/13.0%) and the least common are agoraphobia (2.5/3.7%) and obsessive-compulsive disorder (2.3/2.7%); second, that the anxiety-mood disorders with the earlier median ages-of-onset are phobias and separation anxiety disorder (ages 15-17) and those with the latest are panic disorder, major depression, and generalized anxiety disorder (ages 23-30); third, that LMR is considerably higher than lifetime prevalence for most anxiety-mood disorders, although the magnitude of this difference is much higher for disorders with later than earlier ages-of-onset; and fourth, that the ratio of 12-month to lifetime prevalence, roughly characterizing persistence, varies meaningfully in ways consistent with independent evidence about differential persistence of these disorders.
根据美国针对 13 岁及以上人群开展的流行病学调查,本研究报告了《精神障碍诊断与统计手册》第四版修订版(DSM-IV-TR)焦虑和心境障碍的 12 个月和终生患病率以及终生患病风险(LMR)的估计值。本报告旨在为即将发布的 DSM-5 手册提供更一致的估计值,这是常规方法无法实现的。本报告根据 DSM-5 工作组提出的最适合政策规划目的的年龄组,报告了患病率估计值。按照出现频率对 LMR/12 个月患病率估计值进行了排名,结果如下:重性抑郁发作:29.9%/8.6%;特定恐惧症:18.4%/12.1%;社交恐惧症:13.0%/7.4%;创伤后应激障碍:10.1%/3.7%;广泛性焦虑障碍:9.0%/2.0%;分离焦虑障碍:8.7%/1.2%;惊恐障碍:6.8%/2.4%;双相障碍:4.1%/1.8%;广场恐惧症:3.7%/1.7%;强迫症:2.7%/1.2%。结果有四个显著特点:首先,美国最常见的终生焦虑-心境障碍(终生患病率/患病风险)是重性抑郁(16.6/29.9%)、特定恐惧症(15.6/18.4%)和社交恐惧症(10.7/13.0%),最不常见的是广场恐惧症(2.5/3.7%)和强迫症(2.3/2.7%);其次,发病年龄较早的焦虑-心境障碍是恐惧症和分离焦虑障碍(15-17 岁),发病年龄较晚的是惊恐障碍、重性抑郁和广泛性焦虑障碍(23-30 岁);再次,LMR 明显高于大多数焦虑-心境障碍的终生患病率,但这种差异在发病年龄较晚的障碍中更为显著;最后,12 个月与终生患病率的比值大致反映了持续性,这种比值的差异方式与这些障碍的不同持续性的独立证据一致。