Kessler R C, Rubinow D R, Holmes C, Abelson J M, Zhao S
Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA.
Psychol Med. 1997 Sep;27(5):1079-89. doi: 10.1017/s0033291797005333.
Data are presented on the general population epidemiology of DSM-III-R bipolar I disorder in the United States.
Data come from the US National Comorbidity Survey (NCS), a general population survey of DSM-III-R disorders. A modified version of the Composite International Diagnostic Interview was used to make diagnoses.
A small (N = 59) clinical reappraisal study showed that the only manic symptom profile that could validly be assessed with the CIDI is characterized by euphoria, grandiosity and the ability to maintain energy without sleep, which described approximately half of all clinically validated bipolar I cases in the NCS. Further analysis focused on this symptom profile, which involved N = 29 cases in the total sample. Lifetime prevalence was estimated to be 0.4% and 12-month prevalence only slightly lower. Caseness was negatively related to income, education and age, positively related to urbanicity, and elevated among the previously married, never married and non-whites. All cases reported at least one other NCS/DSM-III-R disorder and 59.3% reported that their episode of bipolar disorder (either mania or depression) occurred at a later age than at least one other NCS/DSM-III-R disorder. Although 93.2% of lifetime cases reported some lifetime treatment, only 44.7% of recent cases were in treatment.
The type of bipolar disorder examined here is highly chronic, co-morbid and impairing. Increased efforts are required to attract current cases into appropriate treatment. Methodological research is needed to develop more accurate measures of other bipolar symptom profiles for use in general population epidemiological studies.
本文呈现了美国DSM-III-R双相I型障碍在普通人群中的流行病学数据。
数据来源于美国国家共病调查（NCS），这是一项针对DSM-III-R障碍的普通人群调查。采用了综合国际诊断访谈的修改版进行诊断。
一项小型（N = 59）临床重新评估研究表明，用CIDI能够有效评估的唯一躁狂症状特征为欣快、夸大以及无需睡眠就能保持精力，这一特征描述了NCS中约一半经临床验证的双相I型病例。进一步分析聚焦于这一症状特征，该特征在总样本中涉及29例。终生患病率估计为0.4%，12个月患病率仅略低。病例与收入、教育程度和年龄呈负相关，与城市化程度呈正相关，在曾婚、未婚和非白人中患病率升高。所有病例均报告至少患有一种其他NCS/DSM-III-R障碍，59.3%的病例报告其双相情感障碍发作（躁狂或抑郁）的年龄晚于至少一种其他NCS/DSM-III-R障碍。尽管93.2%的终生病例报告曾接受过某种终生治疗，但近期病例中只有44.7%正在接受治疗。
本文所研究的双相情感障碍类型具有高度慢性、共病性且会造成损害。需要加大力度吸引当前病例接受适当治疗。需要开展方法学研究以开发更准确的其他双相症状特征测量方法，用于普通人群流行病学研究。
