Stein Dan J, Scott Kate M, de Jonge Peter, Kessler Ronald C
University of Cape Town and MRC Unit on Risk & Resilience in Mental Disorders, South Africa.
University of Otago, New Zealand.
Dialogues Clin Neurosci. 2017 Jun;19(2):127-136. doi: 10.31887/DCNS.2017.19.2/dstein.
On the basis of epidemiological survey findings, anxiety disorders are the most prevalent mental disorders around the world and are associated with significant comorbidity and morbidity. Such surveys rely on advances in psychiatric nosology and may also contribute usefully to revisions of the nosology. There are a number of questions at the intersection of psychiatric epidemiology and nosology. This review addresses the following: What is the prevalence of anxiety disorders and how do we best explain cross-national differences in prevalence estimates? What are the optimal diagnostic criteria for anxiety disorders, and how can epidemiological data shed light on this question? What are the comorbidities of anxiety disorders, and how do we best understand the high comorbidities seen in these conditions? What is the current treatment gap for anxiety disorders, and what are the implications of current understandings of psychiatric epidemiology and nosology for policy-making relevant to anxiety disorders? Here, we emphasize that anxiety disorders are the most prevalent of the psychiatric conditions, and that rather than merely contrasting cross-national prevalence in anxiety disorders, it is more productive to delineate cross-national themes that emerge about the epidemiology of these conditions. We discuss that optimizing diagnostic criteria for anxiety disorders is an iterative process to which epidemiological data can make a crucial contribution. Additionally, high comorbidity in anxiety disorders is not merely artefactual; it provides key opportunities to explore pathways to mental disorders and to intervene accordingly. Finally, work on the epidemiology and nosology of anxiety disorders has provided a number of important targets for mental health policy and for future integrative work to move between bench and bedside, as well as between clinic and community.
基于流行病学调查结果，焦虑症是全球最普遍的精神障碍，且与显著的共病性和发病率相关。此类调查依赖于精神疾病分类学的进展，也可能对分类学的修订有很大帮助。在精神科流行病学和分类学的交叉领域存在一些问题。本综述探讨以下内容：焦虑症的患病率是多少，以及我们如何最好地解释患病率估计中的跨国差异？焦虑症的最佳诊断标准是什么，以及流行病学数据如何阐明这个问题？焦虑症的共病情况如何，以及我们如何最好地理解这些病症中出现的高共病率？焦虑症目前的治疗差距是什么，以及当前对精神科流行病学和分类学的理解对与焦虑症相关的政策制定有何影响？在此，我们强调焦虑症是最普遍的精神疾病，与其仅仅对比焦虑症的跨国患病率，更有成效的做法是勾勒出这些病症流行病学中出现的跨国主题。我们讨论了优化焦虑症诊断标准是一个迭代过程，流行病学数据可为其做出关键贡献。此外，焦虑症的高共病率并非仅仅是人为造成的；它为探索精神障碍的发病途径并据此进行干预提供了关键机会。最后，关于焦虑症流行病学和分类学的研究为心理健康政策以及未来从实验室到临床、从诊所到社区的整合工作提供了许多重要目标。
