世界心理健康调查中不同国家的儿童期起病和成年期起病的分离焦虑障碍
Pediatric-Onset and Adult-Onset Separation Anxiety Disorder Across Countries in the World Mental Health Survey.
作者信息
Silove Derrick, Alonso Jordi, Bromet Evelyn, Gruber Mike, Sampson Nancy, Scott Kate, Andrade Laura, Benjet Corina, Caldas de Almeida Jose Miguel, De Girolamo Giovanni, de Jonge Peter, Demyttenaere Koen, Fiestas Fabian, Florescu Silvia, Gureje Oye, He Yanling, Karam Elie, Lepine Jean-Pierre, Murphy Sam, Villa-Posada Jose, Zarkov Zahari, Kessler Ronald C
机构信息
From the Psychiatry Research and Teaching Unit and Ingham Institute, School of Psychiatry, University of New South Wales, Randwick, NSW, Australia; IMIM-Hospital del Mar Research Institute, Parc de Salut Mar, Pompeu Fabra University (UPF) and CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, N.Y..; Department of Health Care Policy, Harvard Medical School, Boston; Department of Psychological Medicine, University of Otago, Otago, New Zealand; Department/Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil; Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico; Chronic Diseases Research Center (CEDOC) and Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portgual; IRCCS St. John of God Clinical Research Centre and IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy; University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Psychiatry, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium; Unit of Analysis and Generation of Evidence for Public Health, Peruvian National Institutes of Health, Lima, Peru; National School of Public Health, Management and Professional Development, Bucharest, Romania; Department of Psychiatry, University College Hospital, Ibadan, Nigeria; Shanghai Mental Health Center, Shanghai, the People's Republic of China; Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon; Department of Psychiatry and Clinical Psychology, St. George Hospital University Medical Center, Beirut, Lebanon; Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon; Hôpital Lariboisière Fernand Widal, Assistance Publique Hôpitaux de Paris, University
出版信息
Am J Psychiatry. 2015 Jul;172(7):647-56. doi: 10.1176/appi.ajp.2015.14091185. Epub 2015 Jun 5.
OBJECTIVE
The age-at-onset criterion for separation anxiety disorder was removed in DSM-5, making it timely to examine the epidemiology of separation anxiety disorder as a disorder with onsets spanning the life course, using cross-country data.
METHOD
The sample included 38,993 adults in 18 countries in the World Health Organization (WHO) World Mental Health Surveys. The WHO Composite International Diagnostic Interview was used to assess a range of DSM-IV disorders that included an expanded definition of separation anxiety disorder allowing onsets in adulthood. Analyses focused on prevalence, age at onset, comorbidity, predictors of onset and persistence, and separation anxiety-related role impairment.
RESULTS
Lifetime separation anxiety disorder prevalence averaged 4.8% across countries (interquartile range [25th-75th percentiles]=1.4%-6.4%), with 43.1% of lifetime onsets occurring after age 18. Significant time-lagged associations were found between earlier separation anxiety disorder and subsequent onset of internalizing and externalizing DSM-IV disorders and conversely between these disorders and subsequent onset of separation anxiety disorder. Other consistently significant predictors of lifetime separation anxiety disorder included female gender, retrospectively reported childhood adversities, and lifetime traumatic events. These predictors were largely comparable for separation anxiety disorder onsets in childhood, adolescence, and adulthood and across country income groups. Twelve-month separation anxiety disorder prevalence was considerably lower than lifetime prevalence (1.0% of the total sample; interquartile range=0.2%-1.2%). Severe separation anxiety-related 12-month role impairment was significantly more common in the presence (42.4%) than absence (18.3%) of 12-month comorbidity.
CONCLUSIONS
Separation anxiety disorder is a common and highly comorbid disorder that can have onset across the lifespan. Childhood adversity and lifetime trauma are important antecedents, and adverse effects on role function make it a significant target for treatment.
目的
《精神疾病诊断与统计手册》第5版（DSM-5）中去除了分离焦虑障碍的起病年龄标准，因此利用跨国数据来研究作为一种起病贯穿一生的疾病的分离焦虑障碍的流行病学情况正逢其时。
方法
样本包括世界卫生组织（WHO）世界心理健康调查中18个国家的38993名成年人。使用WHO复合国际诊断访谈来评估一系列DSM-IV疾病，其中包括对分离焦虑障碍的扩展定义，允许在成年期起病。分析重点在于患病率、起病年龄、共病情况、起病和持续存在的预测因素，以及与分离焦虑相关的角色功能损害。
结果
各国终生分离焦虑障碍的患病率平均为4.8%（四分位距[第25 - 75百分位数]=1.4% - 6.4%），43.1%的终生起病发生在18岁之后。在早期分离焦虑障碍与随后出现的内化和外化DSM-IV疾病之间，以及相反地在这些疾病与随后出现的分离焦虑障碍之间，发现了显著的时间滞后关联。终生分离焦虑障碍的其他一致显著的预测因素包括女性性别、回顾性报告的童年逆境以及终生创伤事件。这些预测因素在儿童期、青少年期和成年期的分离焦虑障碍起病情况以及不同国家收入组中大致相当。12个月的分离焦虑障碍患病率显著低于终生患病率（占总样本的1.0%；四分位距=0.2% - 1.2%）。在存在12个月共病（42.4%）的情况下，与分离焦虑相关的严重12个月角色功能损害比不存在共病（18.3%）时显著更常见。
结论
分离焦虑障碍是一种常见且共病率高的疾病，可在一生中起病。童年逆境和终生创伤是重要的前驱因素，并且对角色功能的不良影响使其成为一个重要的治疗靶点。
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