Kessler R C, McGonagle K A, Zhao S, Nelson C B, Hughes M, Eshleman S, Wittchen H U, Kendler K S
Institute for Social Research, University of Michigan, Ann Arbor.
Arch Gen Psychiatry. 1994 Jan;51(1):8-19. doi: 10.1001/archpsyc.1994.03950010008002.
This study presents estimates of lifetime and 12-month prevalence of 14 DSM-III-R psychiatric disorders from the National Comorbidity Survey, the first survey to administer a structured psychiatric interview to a national probability sample in the United States.
The DSM-III-R psychiatric disorders among persons aged 15 to 54 years in the noninstitutionalized civilian population of the United States were assessed with data collected by lay interviewers using a revised version of the Composite International Diagnostic Interview.
Nearly 50% of respondents reported at least one lifetime disorder, and close to 30% reported at least one 12-month disorder. The most common disorders were major depressive episode, alcohol dependence, social phobia, and simple phobia. More than half of all lifetime disorders occurred in the 14% of the population who had a history of three or more comorbid disorders. These highly comorbid people also included the vast majority of people with severe disorders. Less than 40% of those with a lifetime disorder had ever received professional treatment, and less than 20% of those with a recent disorder had been in treatment during the past 12 months. Consistent with previous risk factor research, it was found that women had elevated rates of affective disorders and anxiety disorders, that men had elevated rates of substance use disorders and antisocial personality disorder, and that most disorders declined with age and with higher socioeconomic status.
The prevalence of psychiatric disorders is greater than previously thought to be the case. Furthermore, this morbidity is more highly concentrated than previously recognized in roughly one sixth of the population who have a history of three or more comorbid disorders. This suggests that the causes and consequences of high comorbidity should be the focus of research attention. The majority of people with psychiatric disorders fail to obtain professional treatment. Even among people with a lifetime history of three or more comorbid disorders, the proportion who ever obtain specialty sector mental health treatment is less than 50%. These results argue for the importance of more outreach and more research on barriers to professional help-seeking.
本研究展示了来自全国共病调查中14种《精神疾病诊断与统计手册》第三版修订本（DSM-III-R）精神障碍的终生患病率和12个月患病率的估计值，该调查是在美国对全国概率样本进行结构化精神科访谈的首次调查。
通过使用修订版的综合国际诊断访谈，由非专业访谈员收集的数据对美国非机构化平民人口中15至54岁人群的DSM-III-R精神障碍进行评估。
近50%的受访者报告至少有一种终生障碍，近30%报告至少有一种12个月内的障碍。最常见的障碍是重度抑郁发作、酒精依赖、社交恐惧症和单纯恐惧症。所有终生障碍中超过一半发生在有三种或更多共病障碍病史的14%的人群中。这些高度共病的人还包括绝大多数患有严重障碍的人。终生患有障碍的人中不到40%曾接受过专业治疗，近期患有障碍的人中不到20%在过去12个月内接受过治疗。与先前的风险因素研究一致，发现女性情感障碍和焦虑障碍的发病率较高，男性物质使用障碍和反社会人格障碍的发病率较高，并且大多数障碍随着年龄增长和社会经济地位提高而下降。
精神障碍的患病率高于先前认为的情况。此外，这种发病率比先前认识到的更高度集中在约六分之一有三种或更多共病障碍病史的人群中。这表明高共病的原因和后果应成为研究关注的焦点。大多数患有精神障碍的人未能获得专业治疗。即使在有三种或更多共病障碍终生病史的人群中，获得专科心理健康治疗的比例也不到50%。这些结果表明了更多外展服务以及对寻求专业帮助的障碍进行更多研究的重要性。
