Mackenzie Corey S, El-Gabalawy Renée, Chou Kee-Lee, Sareen Jitender
Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.
Department of Asian and Policy Studies, The Hong Kong Institute of Education.
Am J Geriatr Psychiatry. 2014 Sep;22(9):854-65. doi: 10.1016/j.jagp.2013.02.007. Epub 2013 Jun 22.
Relatively little is known about whether mental disorders other than depression remit versus persist in later life, especially within nationally representative samples. Our objectives were to examine the prevalence of persistent mood, anxiety, and substance disorders in older adults and to explore a range of physical and mental health predictors of disorder chronicity.
This study involved a 3-year follow-up design using Wave 1 (2001-2002) and Wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions. Participants included 1,994 adults aged 55 years and older who had a past-year mental disorder at Wave 1 and who completed Wave 2. The primary outcome was the prevalence of persistent mood, anxiety, and substance disorders at Wave 2. Potential predictors of persistence included sociodemographic variables, physical health (chronic health conditions and physical health-related quality of life), and mental health (childhood adversity, suicide attempts, mental health-related quality of life, comorbid mental disorders, personality disorders, and lifetime treatment-seeking).
With the exception of nicotine dependence, the prevalence of persistent mood, anxiety, and substance disorders ranged from 13% to 33%. Only younger age predicted substance disorder chronicity. Significant predictors of persistent mood and anxiety disorders included physical and mental health comorbidity, physical health- and mental health-related quality of life, suicide attempts, comorbid personality disorders, and treatment-seeking.
At least two-thirds of mental disorders in these older adults were not persistent. Sociodemographic variables had little influence on chronicity, whereas a number of markers of mental disorder severity and complexity predicted persistent mood and anxiety disorders. The findings have important treatment and prevention implications.
除抑郁症外，其他精神障碍在晚年是缓解还是持续存在，我们所知相对较少，尤其是在具有全国代表性的样本中。我们的目的是研究老年人中持续性情绪、焦虑和物质使用障碍的患病率，并探索一系列身心健康因素对障碍慢性化的预测作用。
本研究采用了3年随访设计，使用了全国酒精及相关状况流行病学调查的第1波（2001 - 2002年）和第2波（2004 - 2005年）数据。参与者包括1994名年龄在55岁及以上的成年人，他们在第1波时有过去一年的精神障碍，并完成了第2波调查。主要结局是第2波时持续性情绪、焦虑和物质使用障碍的患病率。持续性的潜在预测因素包括社会人口统计学变量、身体健康（慢性健康状况和与身体健康相关的生活质量）以及心理健康（童年逆境、自杀未遂、与心理健康相关的生活质量、共病精神障碍、人格障碍和终生寻求治疗）。
除尼古丁依赖外，持续性情绪、焦虑和物质使用障碍的患病率在13%至33%之间。只有年龄较小预测物质使用障碍的慢性化。持续性情绪和焦虑障碍的显著预测因素包括身心健康共病、与身体健康和心理健康相关的生活质量、自杀未遂、共病的人格障碍以及寻求治疗。
这些老年人中至少三分之二的精神障碍并非持续性的。社会人口统计学变量对慢性化影响不大，而一些精神障碍严重程度和复杂性的指标预测了持续性情绪和焦虑障碍。这些发现对治疗和预防具有重要意义。
