National Comorbidity Survey - Adolescent (NCS-A)

全国合并症调查 - 青少年 (NCS-A)

• 批准号: 8158109
• 负责人: kathleen r merikangas
• 金额: $ 34.22万
• 依托单位: NATIONAL INSTITUTE OF MENTAL HEALTH
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/8158109
• 关键词: Adolescent; Comorbidity; National Survey of Adolescents; Surveys

During the past year, the major methodological and basic descriptive data have been summarized and submitted for publication. The methodological papers described the NCS-A background and measures (Merikangas et al 2009), study design and sampling (Kessler et al, 2009), field procedures (Kessler et al, 2009) and concordance of DSM-IV diagnosis from CIDI interview with clinical reassessments (Kessler et al, 2009). In addition, substantial work by our Harvard collaborators on the validity of individual diagnostic entities in the NCS-A diagnostic interview has been completed, and several manuscripts describing this work are in various stages of publication (Green et al, a, b, c) The primary effort of the NIMH team during the past year has been to review the diagnostic algorithms that were initially developed at Harvard University in order to , to define severity of cases using higher thresholds for impairment, to develop definitions of subthreshold disorders, and to create variables for service utilization. We have also processed the diagnostic data, developed codebooks and began constructing secondary variables for analysis. The NIMH team has also made substantial progress on defining the priorities for descriptive analyses of several specific disorders including mood, anxiety, eating, migraine, and substance abuse. Work groups including both intramural and extramural collaborators have been established in each of these areas. These efforts have yielded several manuscripts covering a wide range of adolescent mental health topics, including: (1) the prevalence of mental disorders in the U.S. adolescent population, (2) service patterns for mental disorders among these youth, and (3) comprehensive, disorder and topic-specific papers that examine mania, major depression, anxiety, and eating disorders, as well as migraine, suicide, tobacco use, and child neglect. The first publication of lifetime prevalence rates the full range of DSM-IV mental disorders in U.S. adolescents and their individual and familial correlates is now in press. The overall prevalence of disorders with severe impairment and/or distress was 22.2%; (11.2% with mood disorders; 8.3% with anxiety disorders; 9.6% behavior disorders). The median age of onset for disorder classes was earliest for anxiety (6 years), followed by 11 years for behavior, 13 years for mood, and 15 years for substance use disorders. We have also completed the analyses of lifetime service patterns for mental disorders in U.S. adolescents in collaboration with Mark Olfson, Ph.D. of Columbia University. Service rates were highest among those with attention-deficit/hyperactivity disorder (68.0%) and behavior disorders (45.4%), but less than one in five affected adolescents received services for their anxiety, eating or substance use disorders. Hispanic and non-Hispanic black adolescents were less likely than their white counterparts to receive services for mood and anxiety disorders, even when such disorders were associated with severe impairment. The manuscript has been submitted for publication. We have recently completed a parallel analysis for patterns of 12-month service utilization. 45% youth with 12 month disorders received services from any source and are in the process of preparing a manuscript reporting these findings in collaboration with our extramural collaborators. Other analyses that have been conducted and submitted for publication include: (1) A latent class analysis (LCA) on a subsample 2,539 adolescents with lifetime anxiety disorders to identify empirical subgroups and to examine their developmental and clinical correlates. A seven class solution provided the best fit among both males and females, with classes defined primarily by the nature rather than the degree of anxiety. The presentation of anxiety disorders among individuals and the observation of unique correlates of classes provide evidence for the utility of individual DSM-IV anxiety disorder categories. Findings emphasize the potential value of early interventions and gender-specific conceptualization and treatment of anxiety disorders. (2) We have also assessed the prevalence and correlates of eating disorders in the NCS-A. We found that the lifetime prevalence of anorexia nervosa, bulimia nervosa, and binge eating disorder were respectively 0.3%, 0.9%, and 1.6%. Important differences were observed between anorexia nervosa and other eating disorders concerning sociodemographic correlates, psychiatric comorbidity and suicidality. Although the majority of adolescents with an eating disorder sought some form of treatment, only a minority received treatment specifically for their eating or weight problems. Their severity is demonstrated by generally strong associations with other psychiatric disorders, role impairment, and suicidality, and the unmet treatment needs in the adolescent population place these disorders as important public health concerns. (3) We have examined the 12 month prevalence and comorbidity with other physical conditions in the NCS-A. Migraine status in the past 12 months was assessed using modified International Headache Society (HIS) criteria. Presence of other physical conditions was assessed using a questionnaire addressed to a parent or parent surrogate and reported across the spectrum of headache sufferers. We found that the prevalence of migraine without aura was 8.0% (4.9% in males and 11.3% in females) and migraine with aura was 0.9% (0.8% in males and 0.9% in females). Individuals with any type of headache more frequently reported other neurologic conditions such as epilepsy, persistent nightmares, and motion sickness. Adolescents with migraine were more likely to have a diagnosis of asthma and seasonal allergies compared to those with non-specific headache. Two manuscripts have been drafted and have been submitted for publication. During the next year, we plan to: (1) expand our understanding of mental disorders and service utilization in adolescents by examining risk and protective factors at the level of the individual, family, and community; (2 )investigate the role of immigration and school/neighborhood factors on mental disorders in youth; (3) examine patterns of comorbidity between mental and physical disorders; (4) conduct analyses among subgroups linking data from other national and international studies; and (5) complete the salivary stress hormone assays and evaluate their association with mental disorders in adolescents. Public Health Impact: Aside from providing the first prevalence data on a wide range of psychiatric disorders in a nationally representative sample of U.S. adolescents, the results of this study demonstrate that common mental disorders in adults first emerge in childhood and adolescence. The severity of disorders under study is also demonstrated by the high degree of comorbidity, clinical distress, role impairment, and suicidality among youth with mental disorders. In consideration of the substantial proportion of young people with severe mental disorders that have never received specialty mental health care, the marked racial disparities in lifetime mental health treatment for mood and anxiety disorders, the magnitude unmet needs in mental health treatment are of great importance in public health. Our results further highlight the need for a transition from the common focus on treatment of U.S. youth to that of prevention and early intervention. Future work on this rich resource will help to address the dramatic personal and societal impact of adolescent mental disorders in order to help establish sound public health policy and design health programs and services.

在过去的一年中，总结了主要的方法论和基本描述性数据并提交出版。该方法论论文描述了NCS-A背景和措施（Merikangas等，2009），研究设计和抽样（Kessler等，2009），现场程序（Kessler等，2009）和DSM-IV诊断与CIDI诊断的一致性以及CIDI访谈的一致性临床重新评估（Kessler等，2009）。此外，我们的哈佛大学合作者对NCS-A-A诊断访谈中各个诊断实体的有效性的大量工作已经完成，并且一些描述这项工作的手稿都处于各个阶段的出版阶段（Green等，A，A，B，C）在过去的一年中，NIMH团队的主要努力是审查哈佛大学最初开发的诊断算法，以定义使用较高阈值的案件的严重性，以制定子阈值障碍的定义，并创建对诊断的定义服务利用的变量。 我们还处理了诊断数据，开发了代码手册，并开始构建次要变量进行分析。 NIMH团队还取得了重大进展，以确定对几种特定疾病的描述性分析的优先事项，包括情绪，焦虑，饮食，偏头痛和滥用药物。这些领域中的每个领域都建立了包括壁内和壁外合作者在内的工作组。 这些努力产生了几个涵盖各种青春期心理健康主题的手稿，包括：（1）美国青少年人群的精神障碍患病率，（2）这些年轻人中精神障碍的服务模式，以及（3）综合，（3）检查躁狂症，重度抑郁症，焦虑和饮食失调以及偏头痛，自杀，烟草使用和忽视儿童的疾病和主题特定论文。 终生患病率的第一个出版物率是美国青少年及其个人和家庭相关性的DSM-IV精神障碍的全部范围。严重损害和/或困扰的疾病的总体患病率为22.2％； （患有情绪障碍的11.2％；焦虑症的8.3％；行为障碍9.6％）。疾病类别的发病年龄中位数是焦虑症（6岁），其次是行为11年，情绪为13年，对药物使用障碍的15岁。 我们还与Mark Olfson博士合作完成了对美国青少年精神障碍的终生服务模式的分析。哥伦比亚大学。注意力缺陷/多动症障碍（68.0％）和行为障碍（45.4％）的服务率最高，但不到五分之一受影响的青少年因其焦虑，饮食或药物使用障碍而获得服务。西班牙裔和非西班牙裔黑人青少年的可能性比白人对焦虑症的服务的可能性较小，即使这种疾病与严重损害有关。手稿已提交出版。我们最近完成了12个月服务使用模式的并行分析。有45％患有12个月疾病的年轻人从任何来源获得服务，并且正在准备手稿，并与我们的壁外合作者合作报告这些发现。 进行并提交出版的其他分析包括： （1）在2,539个患有终生焦虑症的青少年的潜在类别分析（LCA），以识别经验亚组并检查其发育和临床相关性。一个七类的解决方案在男性和女性中都提供了最佳拟合度，其类别主要由性质而不是焦虑程度定义。个体之间焦虑症的介绍和班级独特相关性的观察为单个DSM-IV焦虑症类别的实用性提供了证据。研究结果强调了早期干预措施的潜在价值以及特定性别的概念化和焦虑症的治疗方法。 （2）我们还评估了NCS-A饮食失调的患病率和相关性。 我们发现，神经性厌食症，神经性贪食症和暴饮暴食障碍的寿命患病率分别为0.3％，0.9％和1.6％。关于社会人口统计学相关，精神病合并症和自杀性，神经性厌食症与其他饮食失调之间观察到了重要差异。尽管大多数饮食失调的青少年都寻求某种形式的治疗方法，但只有少数因素专门用于饮食或体重问题。与其他精神疾病，角色障碍和自杀性的密切联系，表现出他们的严重性，并且在青少年人群中未满足的治疗需求将这些疾病视为重要的公共卫生问题。 （3）我们已经检查了NCS-A中其他身体状况的12个月患病率和合并症。在过去的12个月中，使用改良的国际头痛协会（他的）标准评估了偏头痛地位。使用涉及父母或父母代理的问卷评估了其他身体状况的存在，并在头痛患者范围内进行了报告。我们发现，没有光环的偏头痛的患病率为8.0％（男性为4.9％，女性为11.3％），具有AURA的偏头痛为0.9％（男性为0.8％，女性为0.9％）。患有任何类型的头痛的人更经常报告其他神经系统疾病，例如癫痫，持续的噩梦和疾病。与非特异性头痛的青少年相比，患有偏头痛的青少年更有可能诊断出哮喘和季节性过敏。已经起草了两个手稿，并已提交出版。 在明年，我们计划：（1）通过检查个人，家庭和社区水平的风险和保护因素，扩大我们对青少年精神障碍和服务利用的理解； （2）调查移民和学校/邻里因素对青年精神障碍的作用； （3）检查精神和身体障碍之间合并症的模式； （4）在连接其他国家和国际研究的数据的子组之间进行分析； （5）完成唾液应激激素分析，并评估其与青少年精神障碍的关联。 公共卫生影响：除了在全国代表性的美国青少年样本中提供有关广泛精神疾病的首次流行数据外，这项研究的结果表明，成年人的常见精神障碍在童年和青少年时期首次出现。 研究中的疾病的严重程度也证明了精神障碍青年的合并症，临床困扰，角色障碍和自杀性的高度证明。 考虑到从未获得过精神卫生保健的严重精神障碍的年轻人的很大比例，这是情绪和焦虑症的终生心理健康治疗中明显的种族差异，精神健康治疗中未满足的需求在很大程度上至关重要。公共卫生。我们的结果进一步凸显了从对美国青年的治疗的共同关注到预防和早期干预的需求。关于这种丰富资源的未来工作将有助于解决青少年精神障碍的巨大个人和社会影响，以帮助建立合理的公共卫生政策以及设计健康计划和服务。