山东省18岁及以上人群精神障碍流行病学调查

目的:了解山东省≥18岁人群精神障碍的患病率及分布特点。方法:采用多阶段分层整群抽样方法,随机抽取山东省5个地级市的5个区和15个县的10个街道和30个乡镇,共计20个居委会和60个行政村,抽取≥18岁人群23987人,由精神科护士用扩展的一般健康问卷(GHQ-12)进行筛查,将调查对象分为精神障碍高、中、低危险组,然后由精神科医生用美国精神障碍诊断与统计手册(DSM-IV)轴Ⅰ障碍定式临床检查患者版对不同比例的高、中和低危人群进行调查,作出有无精神障碍及具体诊断。结果:完成调查22718人,调整后精神障碍总的现患率(最近1个月)为19.48%(95%CI:17.48%～21.64%)。各类精神障碍现患率由高到低依次为心境障碍(5.93%)、物质使用障碍(5.62%)、焦虑障碍(5.50%)、精神病性障碍(1.28%)。男性精神障碍总的现患率(22.78%)高于女性(16.17%)(OR=1.53)。城市居民精神障碍的现患率(18.88%)与农村(19.68%)之间的差异无统计学意义。最常见的精神障碍依次为酒精使用障碍(5.55%)、心境恶劣障碍(1.99%)、重性抑郁障碍(1.50%)和精神分裂症(1.12%)。有精神障碍者中仅10.53%曾因心理问题在医疗机构就诊,但仅7.69%曾在精神科就诊。结论:精神卫生问题,特别是酒精使用障碍、重性抑郁障碍、心境恶劣障碍和精神分裂症,已成为山东省突出的公共卫生问题。

Epidemiological survey of mental disorders in persons aged 18 years and older in Shandong Province

Objective; To determine the prevalence and distribution of mental disorders in adults 18 years of age and older in Shandong Province. Methods: Stratified multistage cluster randomization was used to identify 23987 individuals≥ 18 years of age from 20 urban neighborhoods (from 10 sub-districts in 5 urban districts) and 60 rural villages (from 30 rural townships in 15 counties) from 5 prefects of the Shandong Province. Subjects were classified as high, moderate or low risk of having a mental disorder based on an expanded version of the General Health Questionnaire (GHQ) (as administered by psychiatric nurses) and then psychiatrists determined their diagnoses by administering the Structured Clinical Interview for DSM-Ⅳ (SCID) to different proportions of the high-, moderate-, and low-risk subjects. Results: Among the 22718 who completed the screening, the prevalence of any current mental disorder was 19.48% (95% CI: 17.48%～21.64%) . The prevalence rates of diagnostic groups of disorders were as follows; mood disorders (5.93%), substance use disorders (5.62%), anxiety disorders (5.50%), and psychotic disorders (1.28%) . The prevalence of any mental disorder was higher in males than in females (22.78% vs. 16.17% , OR = 1.53) . There was no significant difference in the prevalence of any mental disorder between urban and rural residents (18. 88% vs. 19.68%) . The current prevalence rates of the most common specific disorders were as follows: 5.55% (alcohol use disorder), 1.99% (dysthymia), 1.50% (major depressive disorder) and 1.12% (schizophrenia) . Only 10.53% of persons with a mental disorder had ever received any type of medical treatment for psychological problems and only 7.69% had ever received treatment from a mental health professional. Conclusion: Mental health issues, particularly alcohol use disorders, major depression, dysthymia and schizophrenia, are already prominent public health problems in Shandong Province.