Department of Psychology, Stony Brook University, Stony Brook, NY, USA.
Department of Psychology, Stony Brook University, Stony Brook, NY, USA.
Compr Psychiatry. 2017 Nov;79:89-97. doi: 10.1016/j.comppsych.2017.02.003. Epub 2017 Feb 9.
Effective interventions have been developed for myriad common psychological and substance use disorders, though they remain highly underutilized. Previous research has shown that the likelihood of treatment utilization varies across disorder diagnosis. However, studies that focus on individual disorders have resulted in a large, piecemeal literature that neglects the high rates of multivariate comorbidity. The current study investigated the association between treatment utilization and transdiagnostic comorbidity factors.
In a nationally representative sample of the United States adult population (N=34,653), we applied the internalizing-externalizing latent comorbidity model to examine its association with lifetime utilization of various treatments for mood, anxiety, and substance use disorders.
Both internalizing and externalizing transdiagnostic factors were positively associated with all forms of treatment utilization. Stronger within-domain domain (e.g., internalizing's association with mood or anxiety treatment) than between-domain (e.g., internalizing's association with substance use disorder treatment) associations were found. Significant antagonistic internalizing-by-externalizing interactions were also observed.
These results underscore the importance of applying a nuanced approach to modeling comorbidity when predicting treatment utilization. Clinical implications are discussed.
尽管已经针对许多常见的心理和物质使用障碍开发了有效的干预措施，但这些措施的利用率仍然很低。先前的研究表明，治疗的利用率因障碍诊断的不同而有所不同。然而，针对个别障碍的研究产生了大量零碎的文献，忽略了高发病率的多变量共病。本研究调查了治疗利用率与跨诊断共病因素之间的关联。
我们在美国成年人口的全国代表性样本（N=34653）中应用内-外向共病模型，以检查其与情绪、焦虑和物质使用障碍的各种治疗方法的终生利用率之间的关联。
内-外向跨诊断因素均与所有形式的治疗利用率呈正相关。在域内（例如，内-外向与情绪或焦虑治疗的关联）比域间（例如，内-外向与物质使用障碍治疗的关联）的关联更强。还观察到显著的拮抗内-外向相互作用。
这些结果强调了在预测治疗利用率时，对共病进行细致建模的重要性。讨论了临床意义。
