Merikangas K R, Angst J, Eaton W, Canino G, Rubio-Stipec M, Wacker H, Wittchen H U, Andrade L, Essau C, Whitaker A, Kraemer H, Robins L N, Kupfer D J
Yale University School of Medicine, Genetic Epidemiology Research Unit, New Haven, Connecticut 06510-3223, USA.
Br J Psychiatry Suppl. 1996 Jun(30):58-67.
Associations between affective disorders, anxiety disorders, and substance use disorders were examined in epidemiological studies conducted in Germany, Switzerland, Puerto Rico, and the mainland US. There was a remarkable degree of similarity across studies in the magnitude and type of specific disorders associated with the affective disorders. Comorbidity with affective disorders was greater for the anxiety disorders than for substance misuse. Panic disorder was the subtype of anxiety that was most highly comorbid with depression. Social phobia was the specific phobic type with the strongest association with the affective disorders. The magnitude of associations between substance misuse and affective disorders generally was quite low and less consistent across sites. No major differences were found in the patterns of comorbidity by gender or age group, affective subtype or prevalence period. The onset of anxiety disorders generally preceded that of depression, whereas alcohol misuse was equally likely to pre-or post-date the onset of affective disorders. Finally, comorbidity was associated with an elevation in treatment rates across all sites, confirming Berkson's paradox on an international level.
在德国、瑞士、波多黎各和美国本土进行的流行病学研究中，对情感障碍、焦虑症和物质使用障碍之间的关联进行了调查。在与情感障碍相关的特定障碍的程度和类型方面，各项研究存在显著程度的相似性。焦虑症与情感障碍的共病率高于物质滥用。惊恐障碍是与抑郁症共病程度最高的焦虑症亚型。社交恐惧症是与情感障碍关联最强的特定恐惧症类型。物质滥用与情感障碍之间关联的程度总体上相当低，且各研究地点之间的一致性较差。在按性别或年龄组、情感亚型或流行时期划分的共病模式中，未发现重大差异。焦虑症的发病通常先于抑郁症，而酒精滥用在情感障碍发病之前或之后出现的可能性相同。最后，共病与所有研究地点的治疗率升高相关，在国际层面证实了伯克森悖论。
