Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Queensland, Australia.
Inala Indigenous Health Services, Inala, Queensland, Australia.
BMJ Open. 2018 Jun 30;8(6):e020196. doi: 10.1136/bmjopen-2017-020196.
To determine, using face-to-face diagnostic interviews, the prevalence of common mental disorders (CMD) in a cohort of adult Indigenous Australians, the cultural acceptability of the interviews, the rates of comorbid CMD and concordance with psychiatrists' diagnoses.
Cross-sectional study July 2014-November 2016. Psychologists conducted Structured Clinical Interviews for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision Axis I Disorders (SCID-I) (n=544). Psychiatrists interviewed a subsample (n=78).
Four Aboriginal Medical Services and the general community located in urban, regional and remote areas of Southern Queensland and two Aboriginal Reserves located in New South Wales.
Indigenous Australian adults.
Cultural acceptability of SCID-I interviews, standardised rates of CMD, comorbid CMD and concordance with psychiatrist diagnoses.
Participants reported that the SCID-I interviews were generally culturally acceptable. Standardised rates (95% CI) of current mood, anxiety, substance use and any mental disorder were 16.2% (12.2% to 20.2%), 29.2% (24.2% to 34.1%), 12.4% (8.8% to 16.1%) and 42.2% (38.8% to 47.7%), respectively-6.7-fold, 3.8-fold, 6.9-fold and 4.2-fold higher, respectively, than those of the Australian population. Differences between this Indigenous cohort and the Australian population were less marked for 12-month (2.4-fold) and lifetime prevalence (1.3-fold). Comorbid mental disorder was threefold to fourfold higher. In subgroups living on traditional lands in Indigenous reserves and in remote areas, the rate was half that of those living in mainstream communities. Moderate-to-good concordance with psychiatrist diagnoses was found.
The prevalence of current CMD in this Indigenous population is substantially higher than previous estimates. The lower relative rates of non-current disorders are consistent with underdiagnosis of previous events. The lower rates among Reserve and remote area residents point to the importance of Indigenous peoples' connection to their traditional lands and culture, and a potentially important protective factor. A larger study with random sampling is required to determine the population prevalence of CMD in Indigenous Australians.
通过面对面的诊断访谈，确定成年澳大利亚原住民队列中常见精神障碍（CMD）的流行率、访谈的文化可接受性、并发 CMD 的发生率以及与精神科医生诊断的一致性。
2014 年 7 月至 2016 年 11 月的横断面研究。心理学家进行了《精神障碍诊断与统计手册》第四版修订本轴 I 障碍的结构临床访谈（SCID-I）（n=544）。精神科医生对亚组（n=78）进行了访谈。
位于昆士兰州南部城市、地区和偏远地区的四个原住民医疗服务机构和一般社区，以及新南威尔士州的两个原住民保留地。
澳大利亚原住民成年人。
SCID-I 访谈的文化可接受性、CMD 的标准化发生率、并发 CMD 以及与精神科医生诊断的一致性。
参与者报告称，SCID-I 访谈在文化上普遍是可接受的。当前心境、焦虑、物质使用和任何精神障碍的标准化发生率（95%置信区间）分别为 16.2%（12.2%至 20.2%）、29.2%（24.2%至 34.1%）、12.4%（8.8%至 16.1%）和 42.2%（38.8%至 47.7%），分别比澳大利亚人口高 6.7 倍、3.8 倍、6.9 倍和 4.2 倍。在传统土地上生活的原住民群体和在偏远地区生活的原住民群体之间的差异在 12 个月（2.4 倍）和终生患病率（1.3 倍）方面则不那么明显。并发精神障碍的发生率高 3 至 4 倍。在居住在主流社区的人群中，居住在原住民保留地和偏远地区的人群的发病率则减半。发现与精神科医生诊断有中度至良好的一致性。
本原住民人群中当前 CMD 的患病率明显高于以往的估计。非当前疾病的相对发病率较低，与以往事件的诊断不足相一致。保留地和偏远地区居民的发病率较低，这表明原住民与他们的传统土地和文化的联系非常重要，这可能是一个重要的保护因素。需要进行更大的随机抽样研究，以确定澳大利亚原住民中 CMD 的人群患病率。
