《国家共病调查十年随访：精神障碍对婚姻结局的长期影响》
Long-term effects of mental disorders on marital outcomes in the National Comorbidity Survey ten-year follow-up.
作者信息
Mojtabai Ramin, Stuart Elizabeth A, Hwang Irving, Eaton William W, Sampson Nancy, Kessler Ronald C
机构信息
Department of Mental Health, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD, USA.
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
出版信息
Soc Psychiatry Psychiatr Epidemiol. 2017 Oct;52(10):1217-1226. doi: 10.1007/s00127-017-1373-1. Epub 2017 Apr 4.
PURPOSE
Epidemiological research has consistently shown an association between mental disorders and marital dissolution. However, this research mostly examined the association of divorce as a risk factor for mental illness. This study prospectively examined the associations of mood, anxiety, and substance use disorders with future marital dissolution and new marriages in a representative population sample.
METHODS
The study used data from the National Comorbidity Survey panel study-a two-wave community epidemiological survey of 5001 participants interviewed in 1990-1992 and re-interviewed in 2001-2003. Mental disorders were ascertained with the Composite International Diagnostic Interview, a fully structured instrument. Associations of baseline lifetime disorders and disorders with onset after the baseline with subsequent divorce and marriage/remarriage were examined using discrete-time survival analysis models.
RESULTS
Mental disorders at baseline or with onset after baseline were associated with significantly greater odds of subsequent divorce among respondents who either were married at baseline or got married after baseline. Mental disorders with onset after baseline were associated with smaller odds of marriage or remarriage. Projections assuming causal effects of mental illness on marital outcomes suggest that preventing the effects of common mood, anxiety, and substance use disorders would be associated with 6.7 million fewer divorces and 3.5 million more marriages in the US population over an 11-year period.
CONCLUSIONS
Individuals with common mental disorders are at greater risk of marital dissolution and are less likely to enter new marriages. These factors contribute to the diminished social engagement and social support for individuals with these disorders. Interventions aimed at improving marital and family relationships could potentially ameliorate the effect of mental disorders on these vital social ties.
目的
流行病学研究一直表明精神障碍与婚姻解体之间存在关联。然而，这项研究大多考察的是离婚作为精神疾病风险因素的关联。本研究前瞻性地考察了情绪、焦虑和物质使用障碍与未来婚姻解体及新婚姻在具有代表性的人群样本中的关联。
方法
本研究使用了全国共病调查小组研究的数据——一项对5001名参与者进行的两波社区流行病学调查，这些参与者在1990 - 1992年接受了访谈，并在2001 - 2003年再次接受访谈。使用综合国际诊断访谈（一种完全结构化的工具）来确定精神障碍。使用离散时间生存分析模型考察基线时的终身障碍以及基线后发病的障碍与随后离婚及结婚/再婚之间的关联。
结果
基线时或基线后发病的精神障碍与基线时已婚或基线后结婚的受访者随后离婚的几率显著增加有关。基线后发病的精神障碍与结婚或再婚的几率较小有关。假设精神疾病对婚姻结局有因果效应的预测表明，在美国人群中，在11年期间预防常见情绪、焦虑和物质使用障碍的影响将使离婚减少670万例，结婚增加350万例。
结论
患有常见精神障碍的个体婚姻解体风险更高，进入新婚姻的可能性更小。这些因素导致了对患有这些障碍的个体社会参与度和社会支持的减少。旨在改善婚姻和家庭关系的干预措施可能会减轻精神障碍对这些重要社会关系的影响。
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