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从青春期到成年早期精神障碍的八年发病率及服务利用情况:墨西哥青少年心理健康调查的纵向随访

Eight-year incidence of psychiatric disorders and service use from adolescence to early adulthood: longitudinal follow-up of the Mexican Adolescent Mental Health Survey.

作者信息

Benjet Corina, Borges Guilherme, Méndez Enrique, Albor Yesica, Casanova Leticia, Orozco Ricardo, Curiel Teresa, Fleiz Clara, Medina-Mora María Elena

机构信息

Instituto Nacional de Psiquiatría Ramón de la Fuente, Calzada México-Xochimilco 101, San Lorenzo Huipulco, Mexico, DF, 14370, Mexico.

出版信息

Eur Child Adolesc Psychiatry. 2016 Feb;25(2):163-73. doi: 10.1007/s00787-015-0721-5. Epub 2015 May 26.

Abstract

Half of mental disorders have their first onset before adulthood when the presence of a disorder may be particularly disruptive to developmental milestones. Retrospective prevalence estimates have been shown to underestimate the burden of mental illness and scarce data are available on the incidence of disorders throughout the adolescent period, especially in developing countries. Thus, the objective was to determine the incidence of mental disorders in an 8-year period from adolescence to young adulthood, onset of service use and their predictors in a Mexican cohort. 1071 respondents from a representative two-wave panel sample participated in the Mexican Adolescent Mental Health Survey in 2005 and in the follow-up survey in 2013. Disorders were evaluated with the World Mental Health Composite International Diagnostic Interview. 37.9% experienced the onset of a psychiatric disorder and 28.4% sought services for the first time. Substance use disorders had the greatest incidence, followed by mood and behavior disorders, anxiety disorders and lastly eating disorders. Sex, age, school dropout, childhood adversities and prior mental disorders predicted the onset of new disorders. Being female, having more educated parents and most classes of disorder predicted first time service use. These findings contribute to a paradigm shift in conceptions of mental disorder similar to how we think of common physical afflictions as near universal experiences across the life course, but less frequent at any given moment. Adolescents are particularly vulnerable. Therefore, public health policy should focus on early universal promotion of positive mental health and structural determinants of mental health.

摘要

一半的精神障碍在成年前首次发作,而疾病的存在可能对发育里程碑产生特别大的干扰。回顾性患病率估计已被证明低估了精神疾病的负担,而且关于整个青少年时期疾病发病率的数据稀缺,尤其是在发展中国家。因此,本研究的目的是确定一个墨西哥队列从青春期到青年期8年期间精神障碍的发病率、首次使用服务的情况及其预测因素。来自具有代表性的两波面板样本的1071名受访者参加了2005年的墨西哥青少年心理健康调查和2013年的随访调查。使用世界心理健康综合国际诊断访谈对疾病进行评估。37.9%的人经历了精神障碍的发作,28.4%的人首次寻求服务。物质使用障碍的发病率最高,其次是情绪和行为障碍、焦虑障碍,最后是饮食障碍。性别、年龄、辍学、童年逆境和既往精神障碍可预测新疾病的发作。女性、父母受教育程度较高以及大多数类型的疾病可预测首次使用服务的情况。这些发现有助于精神障碍观念的范式转变,类似于我们如何将常见身体疾病视为贯穿生命历程的几乎普遍经历,但在任何特定时刻发生频率较低。青少年尤其脆弱。因此,公共卫生政策应侧重于早期普遍促进积极的心理健康以及心理健康的结构性决定因素。

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