Szaflarski Magdalena, Bauldry Shawn, Cubbins Lisa A, Meganathan Karthikeyan
Department of Sociology, University of Alabama at Birmingham, HHB 460Q, 1720 2 Ave S, Birmingham, AL 35294-1152; phone: 205-975-5614; fax: 205-975-5614.
Department of Sociology, University of Washington, 3971 Dayton Ave. N., Seattle, WA 98103.
Res Sociol Health Care. 2017;35:171-191.
This study investigated disparities in dual diagnosis (comorbid substance-use and depressive/anxiety disorders) among US adults by nativity and racial-ethnic origin and socioeconomic, cultural, and psychosocial factors that may account for the observed disparities.
DESIGN/METHODOLOGY: The study drew on data from two waves of the National Epidemiological Survey on Alcohol and Related Conditions. Racial-ethnic categories included African, Asian/Pacific Islander, European, Mexican, Puerto Rican, and other Hispanic/Latino. Substance-use and depressive/anxiety disorders were assessed per DSM-IV. A four-category measure of comorbidity was constructed: no substance-use or psychiatric disorder; substance-use disorder only; depressive/anxiety disorder only; and, dual diagnosis. The data were analyzed using multinomial logistic regression.
The prevalence of dual diagnosis was low but varied by nativity, with the highest rates among Europeans and Puerto-Ricans born in US states, and the lowest among Mexicans and Asians/Pacific Islanders. The nativity and racial-ethnic effects on likelihood of having dual diagnosis remained significant after all adjustments.
The limitations included measures of immigrant status, race-ethnicity, and stress and potential misdiagnosis of mental disorder among ethnic minorities.
This new knowledge will help to guide public health and health care interventions addressing immigrant mental and behavioral health gaps.
ORIGINALITY/VALUE: This study addressed the research gap in regard to the prevalence and correlates of dual diagnosis among immigrants and racial-ethnic minorities. The study used the most current and comprehensive data addressing psychiatric conditions among US adults and examined factors rarely captured in epidemiologic surveys (e.g., acculturation).
本研究调查了美国成年人中双重诊断（物质使用与抑郁/焦虑障碍共病）在出生国别、种族和族裔出身方面的差异，以及可能解释所观察到的差异的社会经济、文化和心理社会因素。
设计/方法：该研究利用了两轮全国酒精及相关疾病流行病学调查的数据。种族和族裔类别包括非洲裔、亚太岛民、欧洲裔、墨西哥裔、波多黎各裔以及其他西班牙裔/拉丁裔。依据《精神疾病诊断与统计手册第四版》（DSM-IV）对物质使用和抑郁/焦虑障碍进行评估。构建了一个四类共病测量指标：无物质使用或精神障碍；仅物质使用障碍；仅抑郁/焦虑障碍；以及双重诊断。使用多项逻辑回归对数据进行分析。
双重诊断的患病率较低，但因出生国别而异，在美国出生的欧洲裔和波多黎各裔中患病率最高，墨西哥裔和亚太岛民中患病率最低。在进行所有调整后，出生国别和种族及族裔对双重诊断可能性的影响仍然显著。
局限性包括移民身份、种族和族裔、压力的测量，以及少数族裔中精神障碍可能的误诊。
这一新知识将有助于指导针对移民心理和行为健康差距的公共卫生和医疗保健干预措施。
原创性/价值：本研究填补了关于移民和少数族裔双重诊断患病率及其相关因素方面的研究空白。该研究使用了关于美国成年人精神疾病状况的最新、最全面的数据，并研究了流行病学调查中很少涉及的因素（如文化适应）。
