Department of Epidemiology, Health Promotion and Health Care Innovation, Public Health Service Amsterdam, Nieuwe Achtergracht 100, 1018WT, Amsterdam, the Netherlands.
Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands.
BMC Psychiatry. 2022 Mar 30;22(1):225. doi: 10.1186/s12888-022-03868-5.
Prevalence rates of anxiety and depression in adolescence are rising markedly in early adolescence. It is important to quantify the non-fatal disease burden of anxiety and depression, such that early interventions can be well targeted, and resources can be allocated in a just and optimal way. This study aimed to estimate the non-fatal disease burden of anxiety and depression with and without suicidal ideation in girls and boys aged 13, 14, and 15 years.
Participants were 53,894 secondary school pupils who completed health questionnaires between September 2018 and July 2019. A design-based approach was used for complex survey data with post-stratification weights and taking clustering at school-level into account. At individual level, disability weights (DWs) were calculated for each disorder. At population level, DWs were multiplied by the point-prevalence per one thousand population of the respective disorders to compute years lived with disability (YLD). DWs and YLD of anxiety and depression were calculated with and without adjustment for comorbid eating disorders, substance use disorders and somatic illnesses.
The unadjusted DW of depression with suicidal ideation (0.30) was greater than without suicidal ideation (0.26), and both were greater than the DW of anxiety (0.24). A similar ranking was obtained after adjusting for comorbidities. At population level, where the prevalence of the disorders come into play, the YLD disease burden was greatest for anxiety, followed by depression with suicidal ideation and depression without suicidal ideation with 17.40, 9.85, and 5.28 YLD per one thousand population, unadjusted for comorbidities. This pattern was the same after adjustment, but then the total YLD of depression with and without suicidal ideation was similar to the YLD of anxiety (12.47 and 12.46, respectively). Girls showed a significantly greater YLD burden of anxiety and depression than boys, but no differences were found between different age groups.
From an individual clinical perspective, depression, especially when accompanied by suicidal ideation, was identified as a major health concern, especially in girls. From a public health perspective, both anxiety and depression, especially when accompanied by suicidal ideation, were identified as major drivers of disease burden, again most notably in girls.
青春期早期，青少年焦虑和抑郁的患病率显著上升。量化焦虑和抑郁的非致命疾病负担非常重要，以便能够进行针对性的早期干预，并以公正和优化的方式分配资源。本研究旨在估计有和没有自杀意念的 13、14 和 15 岁女孩和男孩的焦虑和抑郁的非致命疾病负担。
参与者为 53894 名中学生，他们于 2018 年 9 月至 2019 年 7 月期间完成了健康问卷。采用基于设计的方法处理复杂的调查数据，采用事后分层加权，并考虑到学校层面的聚类。在个体层面，为每种疾病计算残疾权重（DW）。在人群层面，将 DW 乘以各自疾病每千人的流行率来计算伤残调整生命年（YLD）。计算了有和没有调整共病饮食障碍、物质使用障碍和躯体疾病的焦虑和抑郁的 DW 和 YLD。
未经调整的有自杀意念的抑郁症的 DW（0.30）大于无自杀意念的 DW（0.26），两者均大于焦虑的 DW（0.24）。在调整共病情况后，也得到了类似的排名。在人群层面，即考虑到疾病的流行率，未经调整共病情况下，每千人的 YLD 疾病负担最大的是焦虑，其次是有自杀意念的抑郁症和无自杀意念的抑郁症，分别为 17.40、9.85 和 5.28 YLD。调整后，模式相同，但随后有自杀意念和无自杀意念的抑郁症的总 YLD 与焦虑相似（分别为 12.47 和 12.46）。女孩的焦虑和抑郁 YLD 负担明显大于男孩，但不同年龄组之间没有差异。
从个体临床角度来看，尤其是伴有自杀意念的抑郁症，被认为是一个主要的健康关注点，尤其是在女孩中。从公共卫生的角度来看，焦虑和抑郁，尤其是伴有自杀意念的，被认为是疾病负担的主要驱动因素，再次在女孩中最为明显。
