Bareis Natalie, Edlund Mark, Ringeisen Heather, Guyer Heidi, Dixon Lisa B, Olfson Mark, Smith Thomas E, Chwastiak Lydia, Monroe-DeVita Maria, Swartz Marvin, Swanson Jeffrey, Sinclair Hancq Elizabeth, Geiger Paul, Kreski Noah T, Stroup T Scott
Department of Psychiatry, Columbia University Irving Medical Center, and New York State Psychiatric Institute, New York City (Bareis, Dixon, Olfson, Smith, Stroup); RTI International, Research Triangle Park, North Carolina (Edlund, Ringeisen, Guyer, Geiger); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Olfson, Kreski); Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle (Chwastiak, Monroe-DeVita), School of Medicine and the Wilson Center for Science and Justice, School of Law, Duke University, Durham, North Carolina (Swartz, Swanson); National Association of State Mental Health Program Directors, Washington, D.C. (Sinclair Hancq).
Psychiatr Serv. 2025 Jan 1;76(1):2-12. doi: 10.1176/appi.ps.20240138. Epub 2024 Sep 23.
Current information on treatment and clinical characteristics of U.S. adults with schizophrenia spectrum disorders (i.e., schizophrenia, schizoaffective, and schizophreniform disorders) may help inform public health policy and service development for this population.
Data were from the U.S. Mental and Substance Use Disorders Prevalence Study, conducted from October 2020 to October 2022. Clinicians administered the Structured Clinical Interview for the DSM-5 for past-year psychiatric and substance use disorder diagnoses among adults ages 18-65 years. Using sampling weights, the authors examined clinical and treatment characteristics among those with schizophrenia spectrum disorders and compared sociodemographic characteristics and comorbid behavioral health conditions of individuals with or without such disorders (N=4,764).
Among 114 adults with schizophrenia spectrum disorders, the most common comorbid conditions were major depressive episode (52%, 95% CI=34%-69%) and alcohol use (23%, CI=3%-43%), cannabis use (20%, 95% CI=1%-39%), and posttraumatic stress (17%, 95% CI=5%-30%) disorders. Global Assessment of Functioning scores were lower among people with than among those without schizophrenia spectrum disorders (mean±SE=44.8±2.0 vs. 77.2±0.5, p<0.01, respectively), indicating worse functioning. In the past year, 71% (95% CI=55%-87%) of adults with schizophrenia spectrum disorders received at least some mental health treatment, and 26% (95% CI=13%-38%) received minimally adequate treatment.
Individuals with schizophrenia spectrum disorders face substantial challenges in the United States, including high rates of comorbid mental health conditions and substance use; few received adequate treatment. A strong social safety net and active clinical interventions are required to address the socioeconomic challenges and unmet mental health service needs of this population.
了解美国患有精神分裂症谱系障碍（即精神分裂症、分裂情感性障碍和精神分裂症样障碍）的成年人的治疗情况和临床特征，可能有助于为该人群的公共卫生政策和服务发展提供参考。
数据来自2020年10月至2022年10月进行的美国精神和物质使用障碍患病率研究。临床医生对18至65岁成年人进行《精神疾病诊断与统计手册》第5版的结构化临床访谈，以诊断过去一年的精神疾病和物质使用障碍。作者使用抽样权重，研究了患有精神分裂症谱系障碍者的临床和治疗特征，并比较了患有或未患有此类障碍的个体的社会人口学特征和共病行为健康状况（N = 4764）。
在114名患有精神分裂症谱系障碍的成年人中，最常见的共病情况是重度抑郁发作（52%，95%置信区间=34%-69%）以及酒精使用障碍（23%，置信区间=3%-43%）、大麻使用障碍（20%，95%置信区间=1%-39%）和创伤后应激障碍（17%，95%置信区间=5%-30%）。患有精神分裂症谱系障碍者的总体功能评估得分低于未患该障碍者（均值±标准误=44.8±2.0 vs. 77.2±0.5，p<0.01），表明功能较差。在过去一年中，71%（95%置信区间=55%-87%）的患有精神分裂症谱系障碍的成年人至少接受了一些心理健康治疗，26%（95%置信区间=13%-38%）接受了最低限度的充分治疗。
在美国，患有精神分裂症谱系障碍的个体面临重大挑战，包括共病心理健康状况和物质使用障碍的高发生率；很少有人接受了充分治疗。需要强大的社会安全网和积极的临床干预措施，以应对该人群的社会经济挑战和未满足的心理健康服务需求。
