Newman D L, Moffitt T E, Caspi A, Silva P A
Department of Psychology, University of Wisconsin-Madison, USA.
J Abnorm Psychol. 1998 May;107(2):305-11. doi: 10.1037//0021-843x.107.2.305.
Disorders from the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American Psychiatric Association, 1987) were assessed in a birth cohort of 961 young adults. Comorbid cases exceeded single-disordered cases in chronic history of mental illness, use of treatments, physical health problems, functional interference in daily life, and impaired adaptation across domains such as work, education, health, and social-support networks. Single-disorder cases were also more impaired than nondisordered cases, but comorbid cases were the most severely impaired. Our findings suggest that (a) samples that underrepresent comorbidity (pure single-disorder cases or student samples) will underestimate effect sizes for relations between a disorder and its correlates, whereas samples that overrepresent comorbidity (clinical or adjudicated samples) will overestimate effect sizes, (b) comorbidity is accompanied by complications that challenge treatment planning, compliance, and coordination of service delivery, and (c) comorbidity is associated with physical, educational, and economic problems that make it a broad societal concern.
依据《精神疾病诊断与统计手册》（第3版，修订版；美国精神病学协会，1987年）对961名年轻成年人出生队列中的精神障碍进行了评估。在精神疾病慢性病史、治疗使用情况、身体健康问题、对日常生活的功能干扰以及在工作、教育、健康和社会支持网络等领域的适应受损方面，共病病例超过了单一疾病病例。单一疾病病例也比无精神障碍病例受损更严重，但共病病例受损最为严重。我们的研究结果表明：（a）共病比例偏低的样本（单纯单一疾病病例或学生样本）会低估一种疾病与其相关因素之间关系的效应量，而共病比例偏高的样本（临床样本或已判定样本）会高估效应量；（b）共病伴随着挑战治疗计划、依从性和服务提供协调的并发症；（c）共病与身体、教育和经济问题相关，这使其成为一个广泛的社会关注点。
