Changing trend in disease burden of mental illness and its risk factors in China, 1990 – 2019
-
摘要:
目的 通过探讨1990 — 2019年中国居民心理性疾病负担及其危险因素的变化趋势,为中国居民心理性疾病的防治提供依据。 方法 基于2019年全球疾病负担(GBD)中国研究开放数据,采用Excel软件,利用患病率、伤残损失寿命年(YLDs)、伤残调整寿命年(DALYs)对1990 — 2019年中国不同性别和年龄人群心理性疾病负担进行描述,结合人群归因分值(PAF)分析中国心理性疾病危险因素的变化趋势。 结果 2019年中国心理性疾病患病率、YLD率、DALY率分别为12055.47/10万、1426.62/10万、1426.78/10万;随着年龄的增长均呈上升趋势,50~69岁疾病负担最为严重;男性心理性疾病患病率、YLD率、DALY率分别为10886.21/10万、1294.39/10万、1294.51/10万,均低于女性的11649.28/10万、1564.03/10万、1564.22/10万。中国心理性疾病归因于儿童性虐待和亲密伴侣暴力的DALYs由1990年的10.63万人年、30.94万人年增长至2019年的14.04万人年、38.01万人年,增长率为32.04 %、22.87 %。与1990年相比,2019年中国心理性疾病归因于儿童性虐待和亲密伴侣暴力的DALYs呈上升趋势(32.04 %、22.87 %),归因于欺凌受害、儿童性虐待和欺凌、铅暴露和其他环境风险的DALYs均呈下降趋势,铅暴露(– 39.58 %)、其他环境风险(– 39.58 %)的DALYs变化幅度最大。1990 — 2019年,儿童性虐待(1.73 %)的PAF值呈上升趋势,欺凌受害、儿童性虐待和欺凌、亲密伴侣暴力、铅暴露、其他环境风险的PAF值呈下降趋势,分别为 – 49.17 %、– 40.09 % 、– 5.39 %、– 53.47 %、– 53.47 % 。2010 — 2019年亲密伴侣暴力的DALY率顺位上升,欺凌受害的DALY率顺位下降。 结论 1990 — 2019年中国心理性疾病负担逐渐加重,伤残是疾病负担的主要来源,老年女性为高危人群,对其开展心理教育,心理分析疏导是预防心理疾病的优先措施。 Abstract:Objective To explore changing trend in disease burden of mental illness and its risk factors in Chinese popula-tion from 1990 to 2019 for providing evidences to prevention and treatment of mental illness. Methods The open data of the Global Burden of Disease Study (GBD) were used in the study. Age-sex-specific prevalence rate, years lived with disability (YLDs) and disability-adjusted life years (DALYs) for 1990, 2000, 2010 and 2019 were adopted to describe the burden of mental illness and combined with population attributable fraction (PAF) to assess the changing trend in the burden. Results Among Chinese residents in 2019, the rate (1/100 000) for mental illness prevalence, YLDs and DALYs were 12 055.47, 1 426.78 and 1 426.62; the rates increased with the increment of age among the residents of various age groups, with the highest rates in the residents aged 50 – 69 years; compared to those in female residents, the rates were lower in male residents (prevalence: 10 886.21 vs. 11 649.28, YLDs: 1 294.39 vs. 1564.03, DALYs: 1 294.51 vs. 1 564.22). The DALYs (million person years) attributed to child sexual abuse and intimate partner violence increased from 1.063 and 3.094 in 1990 to 1.404 and 3.801 in 2019, with the increases of 32.04% and 22.87%. The DALYs attributed to bullying victimization, child sexual abuse and bullying, lead exposure and other environmental risks declined, with the highest decrease of 39.58% for both DALYs attributed to lead exposure and other environmental hazards. In comparison to that in 1990, the PAF of DALYs attributed to child sexual abuse increased by 1.73% in 2019; however, the PAF of DALYs attributed to bullying, child sexual abuse and bullying, intimate partner violence, lead exposure, and other environmental hazards decreased by 49.17%, 40.09%, 5.39%, 53.47%, and 53.47%, respectively. The DALYs due to intimate partner violence rose but that due to bullying declined during 2010 – 2019. Conclusion The disease burden of mental illness gradually increased from 1990 to 2019 among residents in China and disability was a main contributor to the burden. Psychological education and counseling should be promoted among the residents, especially among the elderly women at a higher risk of mental illness. -
Key words:
- mental illness /
- disease burden /
- risk factor /
- years lived with disability /
- variation tendency
-
表 1 中国1990 — 2019年心理性疾病负担及变化趋势
年龄组(岁) 年份 患病率(1/10万) YLD率(1/10万) DALY率(1/10万) 男性 女性 合计 男性 女性 合计 男性 女性 合计 < 5 1990 2072.93 1212.24 1666.71 155.03 73.27 116.44 155.03 73.27 116.44 2000 2049.48 1164.89 1642.67 153.21 71.23 115.51 153.21 71.23 115.51 2010 1899.32 981.42 1482.44 147.45 64.44 109.75 147.45 64.44 109.75 2019 1786.83 898.93 1376.95 144.39 62.02 106.36 144.39 62.02 106.36 变化率(%) 1990 — 2019 – 0.14 – 0.26 – 0.17 – 0.07 – 0.15 – 0.09 – 0.07 – 0.15 – 0.09 5~14 1990 11916.25 8007.89 10032.95 792.16 679.66 737.95 792.16 679.74 737.99 2000 13508.41 9532.57 11629.27 891.35 808.56 852.22 891.36 808.71 852.29 2010 13252.83 8844.87 11225.69 842.11 740.61 795.44 842.13 740.76 795.51 2019 12643.77 8407.43 10701.33 807.34 706.88 761.28 807.36 707.03 761.36 变化率(%) 1990 — 2019 0.06 0.05 0.07 0.02 0.04 0.03 0.02 0.04 0.03 15~49 1990 12223.55 13133.56 12663.30 1413.40 1810.11 1605.11 1413.42 1810.31 1605.21 2000 11844.68 12824.39 12321.16 1420.59 1738.43 1575.17 1420.60 1738.74 1575.33 2010 11206.12 11659.45 11428.53 1351.24 1581.12 1464.02 1351.40 1581.44 1464.26 2019 11076.00 11495.41 11280.31 1366.81 1604.78 1482.74 1367.05 1605.13 1483.03 变化率(%) 1990 — 2019 – 0.09 – 0.12 – 0.11 – 0.03 – 0.11 – 0.08 – 0.03 – 0.11 – 0.08 50~69 1990 11924.55 14647.09 13236.98 1535.68 1932.96 1727.20 1535.68 1932.96 1727.20 2000 12123.22 15387.29 13700.40 1602.69 2054.58 1821.04 1602.69 2054.58 1821.04 2010 11788.26 14684.09 13211.38 1579.63 2007.43 1789.87 1579.63 2007.43 1789.87 2019 11805.16 14507.43 13155.89 1593.44 2024.74 1809.02 1593.44 2024.74 1809.02 变化率(%) 1990 — 2019 – 0.01 – 0.01 – 0.01 0.04 0.05 0.05 0.04 0.05 0.05 ≥ 70岁 1990 11132.33 13819.79 12660.19 1329.20 1664.14 1519.62 1329.20 1664.14 1519.62 2000 11329.07 14540.05 13097.66 1368.91 1753.62 1580.81 1368.91 1753.62 1580.81 2010 11315.89 14211.97 12875.92 1391.53 1768.33 1594.50 1391.53 1768.33 1594.50 2019 11356.46 14108.54 12853.39 1422.34 1795.02 1625.05 1422.34 1795.02 1625.05 变化率(%) 1990 — 2019 0.02 0.02 0.02 0.07 0.08 0.07 0.07 0.08 0.07 合计 1990 11087.18 11329.76 11204.71 1191.99 1458.44 1321.08 1192.00 1458.56 1321.15 2000 11495.42 12012.70 11746.06 1266.26 1526.78 1392.49 1266.27 1526.98 1392.59 2010 11056.94 11611.43 12176.84 1272.40 1516.66 1391.65 1272.49 1516.86 1391.80 2019 10886.21 11649.28 12055.47 1294.39 1564.03 1426.62 1294.51 1564.22 1426.78 变化率(%) 1990 — 2019 – 0.02 0.03 0.08 0.09 0.07 0.08 0.09 0.07 0.08 表 2 中国1990 — 2019年心理性疾病危险因素的归因DALY和PAF变化趋势
危险因素 DALYs(万人年) PAF(%) 1990年 2000年 2010年 2019年 总增长率(%) 1990年 2000年 2010年 2019年 总增长率(%) 行为危险因素 欺凌受害 49.90 51.43 40.60 32.89 – 34.07 0.03 0.03 0.02 0.02 – 49.17 儿童性虐待 10.63 11.51 11.41 14.04 32.04 0.01 0.01 0.01 0.01 1.73 儿童虐待和欺凌 60.08 62.58 51.73 46.69 – 22.29 0.04 0.03 0.03 0.02 – 40.09 亲密伴侣暴力 30.94 27.40 30.34 38.01 22.87 0.02 0.02 0.02 0.02 – 5.39 环境危险因素 铅暴露 25.35 24.01 18.44 15.32 – 39.58 0.02 0.01 0.01 0.01 – 53.47 其他环境风险 25.35 24.01 18.44 15.32 – 39.58 0.02 0.01 0.01 0.01 – 53.47 -
[1] 钱铭怡. 变态心理学[M]. 北京: 北京大学出版社, 2006: 2 – 3. [2] 翟金国, 赵靖平. DALY及精神障碍的疾病负担[J]. 国外医学精神病学分册, 2004, 31(3): 143 – 146. [3] Purtle J, Klassen AC, Kolker J, et al. Prevalence and correlates of local health department activities to address mental health in the United States[J]. Preventive Medicine, 2016, 82: 20 – 27. doi: 10.1016/j.ypmed.2015.11.007 [4] Centers for Disease Control and Prevention (CDC). Vital signs: current cigarette smoking among adults aged ≥ 18 years with mental illness – United States, 2009 – 2011[J]. Morbidity and Mortality Weekly Report (MMWR), 2013, 62(5): 81 – 87. [5] 屈彦, 王天一, 杨津, 等. GBD数据库的数据提取方法与流程[J]. 中国循证心血管医学杂志, 2019, 11(9): 1043 – 1046. doi: 10.3969/j.issn.1674-4055.2019.09.04 [6] GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990 – 2019: a systematic analysis for the Global Burden of Disease Study 2019[J]. The Lancet, 2020, 396(10258): 1204 – 1222. doi: 10.1016/S0140-6736(20)30925-9 [7] GBD 2019 Viewpoint Collaborators. Five insights from the Global Burden of Disease Study 2019[J]. The Lancet, 2020, 396(10258): 1135 – 1159. doi: 10.1016/S0140-6736(20)31404-5 [8] Song J, Pan RB, Yi WZ, et al. Ambient high temperature exposure and global disease burden during 1990 – 2019: an analysis of the Global Burden of Disease Study 2019[J]. Science of the Total Environment, 2021, 787: 147540. doi: 10.1016/j.scitotenv.2021.147540 [9] GBD 2017 Causes of Death Collaborators. Global, regional, and national age - sex - specific mortality for 282 causes of death in 195 countries and territories, 1980 – 2017: a systematic analysis for the Global Burden of Disease Study 2017[J]. The Lancet, 2018, 392(10159): 1736 – 1788. doi: 10.1016/S0140-6736(18)32203-7 [10] 姚芳传. 精神疾病的诊断和治疗[J]. 校园心理, 2011, 9(6): 363 – 364. doi: 10.3969/j.issn.1673-1662.2011.06.002 [11] 李茜瑶, 周莹, 黄辉, 等. 疾病负担研究进展[J]. 中国公共卫生, 2018, 34(5): 777 – 780. doi: 10.11847/zgggws1118319 [12] 陶庄, 杨功焕. 反事实和归因疾病负担研究[J]. 中华流行病学杂志, 2010, 31(4): 466 – 468. doi: 10.3760/cma.j.issn.0254-6450.2010.04.025 [13] Bruzzi P, Green SB, Byar DP, et al. Estimating the population attributable risk for multiple risk factors using case - control data[J]. American Journal of Epidemiology, 1985, 122(5): 904 – 914. doi: 10.1093/oxfordjournals.aje.a114174 [14] 谢丽, 张焕玲, 唐认桥, 等. 队列研究中多因素调整人群归因危险度的估计及其应用[J]. 中国肿瘤, 2013, 22(5): 373 – 378. [15] 李强, 高文珺, 龙鲸, 等. 心理疾病患者自我污名及影响初探[J]. 中国临床心理学杂志, 2010, 18(3): 323 – 325, 319. [16] 陈秀云, 毕清泉, 任俊翠, 等. 基于心理健康双因素模型的护理本科生心理健康研究进展[J]. 中华护理教育, 2020, 17(10): 953 – 956. doi: 10.3761/j.issn.1672-9234.2020.10.018 [17] Gaebel W, Riesbeck M, Zielasek J, et al. Internetbasierte Untersuchungen zur diagnostischen Klassifikation und Kodierung psychischer Störungen im Vergleich von ICD-11 und ICD-10[J]. Fortschritte der Neurologie Psychiatrie, 2018, 86(3): 163 – 171. doi: 10.1055/s-0044-100508 [18] 郗朝堂. 论心理疾病与年龄关系及其治疗对策[J]. 邯郸师专学报, 1999(1): 71 – 73. [19] Ivbijaro G. The case for change: the global mental health action plan 2013 – 2020[J]. Mental Health in Family Medicine, 2012, 9(3): 135. [20] 陈媛, 潘惊萍, 段占祺, 等. 2015 — 2017年四川省疾病负担研究[J]. 现代预防医学, 2020, 47(20): 3737 – 3741. [21] 刘巧玲. 职业女性心理压力分析及对策[J]. 学理论, 2015(28): 109 – 110. doi: 10.3969/j.issn.1002-2589.2015.28.052 [22] Axinn WG, Ghimire DJ, Williams NE, et al. Gender, traumatic events, and mental health disorders in a rural Asian setting[J]. Journal of Health and Social Behavior, 2013, 54(4): 444 – 461. doi: 10.1177/0022146513501518 [23] 严真化. 切不可轻视精神和心理性疾病[J]. 医学与哲学, 2005, 26(4): 1,5. [24] 王顺铨, 陈正平, 陈晓华, 等. 精神疾病患者生存质量现状的调查[J]. 中国康复, 2006, 21(1): 65. doi: 10.3870/j.issn.1001-2001.2006.01.040 [25] 江光荣, 李丹阳, 任志洪, 等. 中国国民心理健康素养的现状与特点[J]. 心理学报, 2021, 53(2): 182 – 198. [26] 尹美善. 中小学生欺凌校内处理程序研究 —— 以L中学为个案[D]. 长春: 东北师范大学, 2019. [27] 陈飞, 王悠清. 1990 — 2019年中国食管癌疾病负担及其变化趋势分析[J]. 中国肿瘤, 2021, 30(6): 401 – 407. doi: 10.11735/j.issn.1004-0242.2021.06.A001