河北省4个地区广泛焦虑症的流行病学调查

Epidemiological survey on generalized anxiety disorder in 4 areas of Hebei province

目的:了解广泛焦虑症的患病率及人口学特点。方法:于2004-10/2005-03随机抽取河北省邯郸、保定、秦皇岛、承德4个地级市18岁以上人口进行全省精神疾病流行病学现场抽样调查工作,总样本24000人。调查筛选工具采用改编后的一般健康问卷12项,以《DSM-Ⅳ-TR轴Ⅰ障碍定式临床检查》病人版为调查的诊断工具。根据被调查者一般健康问卷12项总分,把被调查者分为高危人群、中危人群、低危人群3类。根据预试验调查结果确定三段危险人群的分界分:总分≥4分属于高危人群,高危人群全部进行DSM-Ⅳ-TR轴Ⅰ障碍定式临床检查;总分为2分或3分即属中危人群,中危人群约40%需进行DSM-Ⅳ-TR轴Ⅰ障碍定式临床检查,总分为0分或1分即属低危人群,低危人群中10%需进行DSM-Ⅳ-TR轴Ⅰ障碍定式临床检查。改编后的一般健康问卷12项分数及内容不变,另外增加8个问题均为高危因素,并进行DSM-Ⅳ-TR轴Ⅰ障碍定式临床检查。结果:①实际完成调查20716人,其中男10343人(49.9%),女10373人(50.1%)。共诊断焦虑症患者127例。②按高中低危因素调整后时点患病率为7.69/1000(95%CI6.50/1000～8.88/1000)。城市患病率4.87/1000,农村患病率8.10/1000,两者差异无显著性意义(u=1.78,P>0.05)。女性患病率明显高于男性,差异有显著性意义(分别为10.42/1000,4.97/1000,u=4.49,P<0.01),男女患病率比例为1:2.10。按不同年龄阶段的人口计算出各年龄段的时点患病率,20～29岁患病率较低(3.17/1000),50～59岁患病率较高(15.56/1000)。③通过12个因素的Logistic回归分析发现,影响广泛焦虑症的危险因素有年龄50～59岁(OR=1.713);保护性因素男性(OR=0.431),年龄20～29岁(OR=0.393),收入10001～20000元(OR=0.568),收入20001～40000元(OR=0.117)。结论:广泛焦虑症的流行病学特征为女性、中老年人患病率较高,男性、青年、收入中等者患病率较低。

AIM： To investigate the prevalence of generalized anxiety disorder and its characteristics in demography. METHODS： A total of 24 000 people older than 18 years came from Handan, Baoding, Qinhuangdao and Chengde of Hebei Province were selected from the epidemiological survey on mental disease of the whole province between October 2004 and March 2005. Revised General Health Questionnaire （GHQ-12） was adopted for the investigation, and Structured Clinical Interview for DSM-Ⅳ-TR Axis Ⅰ Disorders-Patient Edition （SCID-I/P） was used for diagnosis. Subjects were divided into high-risk group, middle-risk group and low-risk group according to their total score of GHQ-12. The score of dividing line for 3 groups of subjects was determined according to the preliminary test： Subjects with the score greater than 4 points belonged to high-risk group, who all underwent DSM-IV-TR SCID- I/P; Subjects with the total score between 2 and 3 points belonged to middle-risk group, and 40% of them shall undergo the test; Subjects with the total score of 0 or 1 point belonged to low-risk group, and 10% of them needed the test. There was no change in the score and contents of revised GHQ-12, while there were 8 questions added for high-risk factors, and DSM-Ⅳ-TR SCID- Ⅰ/P was performed. RESULTS： ① 20 716 people accomplished the survey, including 10 343 males （49.9%） and 10 373 females （50.1%）. A total of 127 patients with anxiety disorder were diagnosed. ② The prevalence of generalized anxiety disorder was 7.69%0 （95% Cl6.50/1 000-8.88%0）. The prevalence in city was 4.87/1000 and was 8.10/1 000 in countryside, and there was no significant difference between the two （u =1.78, P 〈 0.05）. It was obvious that the prevalence in females was higher than that in males, and the difference were remarkable （which were respectively 10.42/1 000,4.97/1 000,u =4.49, P 〈 0.01）. It was 1：2.10 between the male and female. The point prevalence of all ages were calculated, and it was lower in patients aged between 20 and 29 years （3.17/1 000）, but was higher in patients aged between 50 and 59 years （15.56/1 000）.③ Logistic analysis of 12 factors showed that risk factors to the disease was ages of 50-59 （OR =1.713）. On the other hand, factors to avoid the disease were male （OR =0.431）, ages of 20-29 yearsand the family average annual income ranged from 10 001 to 20 000 RMB （OR =0.568） and that ranged from 20 001 to 40 000 RMB （OR =0.117）. CONCLUSION： Generalized anxiety disorder has become common disease. The prevalence rates in females and elderly people are higher, while it is lower in males, young people and people with moderate income.