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绘制常见精神障碍图谱:国家酒精相关情况和条件的流行病学调查中的结构和预测有效性。

Mapping common psychiatric disorders: structure and predictive validity in the national epidemiologic survey on alcohol and related conditions.

机构信息

College of Physicians and Surgeons, Department of Psychiatry, Columbia University, NewYork, NY 10032, USA.

出版信息

JAMA Psychiatry. 2013 Feb;70(2):199-208. doi: 10.1001/jamapsychiatry.2013.281.

Abstract

CONTEXT Clinical experience and factor analytic studies suggest that some psychiatric disorders may be more closely related to one another, as indicated by the frequency of their co-occurrence, which may have etiologic and treatment implications. OBJECTIVE To construct a virtual space of common psychiatric disorders, spanned by factors reflecting major psychopathologic dimensions, and locate psychiatric disorders in that space, as well as to examine whether the location of disorders at baseline predicts the prevalence and incidence of disorders at 3-year follow-up. DESIGN, SETTING, AND PATIENTS A total of 34 653 individuals participated in waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. MAIN OUTCOME MEASURES The distance between disorders at wave 1, calculated using the loadings of the factors spanning the space of disorders as coordinates. This distance was correlated with the adjusted odds ratios for age, sex, and race/ethnicity of the prevalence and incidence of Axis I disorders in wave 2, with the aim of determining whether smaller distances between disorders at wave 1 predicts higher disorder prevalence and incidence at wave 2. RESULTS A model with 3 correlated factors provided an excellent fit (Comparative Fit Index = 0.99, Tucker-Lewis Index = 0.98, root mean square error of approximation = 0.008) for the structure of common psychiatric disorders and was used to span the space of disorders. Distances ranged from 0.070 (between drug abuse and alcohol dependence) to 1.032 (between drug abuse and dysthymia). The correlation of distance between disorders in wave 1 with adjusted odds ratios of prevalence in wave 2 was -0.56. The correlation of distance in wave 1 with adjusted odds ratios of incidence in wave 2 was -0.57. CONCLUSIONS Mapping psychiatric disorders can be used to quantify the distances among disorders. Proximity in turn can be used to predict prospectively the incidence and prevalence of Axis I disorders.

摘要

背景

临床经验和因子分析研究表明,一些精神障碍可能彼此更为密切相关,这反映在它们共同发生的频率上,这可能具有病因和治疗意义。

目的

构建一个常见精神障碍的虚拟空间,该空间由反映主要精神病理维度的因子来跨越,并在该空间中定位精神障碍,同时检查障碍在基线时的位置是否预测 3 年后随访时障碍的患病率和发病率。

设计、地点和患者:共有 34653 人参加了国家酒精和相关条件流行病学调查的第 1 波和第 2 波。

主要结果测量

使用跨越障碍空间的因子的加载作为坐标,计算第 1 波障碍之间的距离。该距离与第 2 波轴 I 障碍的患病率和发病率的年龄、性别和种族/民族调整后比值比相关,目的是确定第 1 波障碍之间的较小距离是否预测第 2 波障碍的更高患病率和发病率。

结果

具有 3 个相关因子的模型为常见精神障碍结构提供了极好的拟合(比较拟合指数=0.99,塔克-刘易斯指数=0.98,均方根误差逼近=0.008),并用于跨越障碍空间。距离范围从 0.070(药物滥用和酒精依赖之间)到 1.032(药物滥用和心境恶劣之间)。第 1 波障碍之间的距离与第 2 波患病率的调整后比值比的相关性为-0.56。第 1 波距离与第 2 波发病率的调整后比值比的相关性为-0.57。

结论

绘制精神障碍图可以用来量化障碍之间的距离。反过来,接近程度可以用于预测轴 I 障碍的发病率和患病率。

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