Bothata bo botle (Bothata kapa Bothata) Papali ea chelete le Axis Ke Mathata a kelello: Liphello ho tsoa Phuputsong ea Sechaba ea Lefu la Tlhaho ka Joala le Melao e Amanang (2011)

LITABA: Boithuto bo ikhethileng ba bolelele. Re fumane hore ho becha ha li-pathological ho ka lebisa ho tsitsipano ea maikutlo, PTSD, matšoenyeho le litumelo tse ling, 3 lilemo hamorao. Ka mantsoe a mang, ho lemalla ho ka baka khatello ea maikutlo, ho fapana le ho ferekana ha maikutlo. Re tlameha ho ba hlokolosi haholo ho nahana hore mathata a maikutlo le a kelello a lula a le teng pele. 

Ke J Epidemiol. 2011 Jun 1; 173 (11): 1289â € “1297.

E hatisitsoe Inthaneteng 2011 Apr 5. doi:  10.1093 / aje / kwr017

PMCID: PMC3139964

Sehlooho sena se bile teng e boletsoeng ke lihlooho tse ling ho PMC.

Eya ho:

inahaneloang

Morero oa bangoli thutong ena e ne e le ho hlahloba karolo ea papali ea chelete e sa pheleng e le sesosa sa kotsi ea ketsahalo e latelang e hlahang. Buka ea ho hlahloba le ea Statistical ea Mathata a kelello, Khatiso ea Bone, mathata a kelello a Axis I kamora ho lokisa maemo a bophelo bo botle, bophelo bo amanang le bophelo bo botle le liketsahalo tse sithabetsang tsa bophelo. Likarabo tsa bolulo ba sechaba tse tsoang mehlaleng e emelang naha ea US (n = 33,231) ho ile ha buisanoa le bona ka 2000â € “2001 le 2004â €“ 2005.

Ho becha ho sa feleng lilemong tsa khale ho ne ho amana le ho hlaha ha lefu la kelello la Axis I, khatello ea maikutlo, ho feto-fetoha ha maikutlo, khatello ea maikutlo, khatello ea maikutlo kapa khatello ea joala kamora ho fetoha. bakeng sa li-variodemographic variables.

Kamora ho feto-fetoha ka nako e le 'ngoe bakeng sa maemo a bongaka, bophelo bo amanang le bophelo bo botle, le liketsahalo tsa bophelo tse sithabetsang tsa morao-rao, ho becha ho sa tsitsitseng ho ile ha lula ho amana haholo le bothata bofe kapa bofe ba maikutlo a ho ferekana, ho tšoenyeha ho akaretsang, khatello ea maikutlo ea morao-rao, mathata a ts'ebeliso ea joala le ts'ebeliso ea joala. Litlamorao tsa bongaka tsa liphumano tsena ke hore bafani ba kalafo ba hloka ho hlahloba bakuli ba papali ea chelete bakeng sa ho feto-fetoha ha maikutlo, matšoenyeho le mathata a ts'ebeliso ea lithethefatsi le ho hlokomela nts'etsopele ea maemo a kamorao a comorbid.

Keywords: komorbidity, ho becha, mathata a kelello

Papali ea papali ea kelello, e khetholloang ke ho becha haholo, taolo ea taolo, tahlehelo ea marang-rang, le ho ts'oara papali ea chelete, ke e 'ngoe ea mathata a taolo a khothalletsang ho Buka ea ho hlahloba le ea Statistical ea Mathata a kelello, Khatiso ea Bone (DSM-IV). Ho ipapisitsoe le lipatlisiso tsa sechaba, litekanyetso tsa ho ata ha papali ea chelete ea bophelo bo botle li tlalehiloe ho tloha ho 0.4% ho 4.0% United States (1-3). Tloaelo ena hangata e bua ka batho ba kopanang bonyane 5 ea mekhoa ea DSM-IV bakeng sa papali ea chelete ea methapo ea mafu (4). â € œProblem gejeke ke polelo e sebelisetsoang ho hlalosa boitšoaro ba papali ea chelete bo lumellanang feela le mekhoa ea 3 kapa 4 DSM-IV ho fapana le mekhoa ea 5, e bonts'ang hore boitšoaro ba papali ea chelete ea ho becha bo na le mathata empa o haelloa ke tlhahlobo ea ts'ebetso ea papali ea papali ea chelete. Phuputso ea morao-rao ea mafu a tšoaetsanoang e bontšitse hore hoo e ka bang 2.5% ea baahi ba United States le Canada ba tla fihlela mekhoa ea ho becha ka mathata (5). Bothata ba papali ea chelete le tšebeliso ea methapo ea maoto li amahantsoe le litšenyehelo tse kholo bakeng sa batho ka bomong, malapa a bona le sechaba (6, 7); ka hona, ho latela pono ea bophelo bo botle ba sechaba, ho bohlokoa ho hlahloba mekhoa ena ea papali ea chelete ea 2. Kahoo, thutong ena re nkile bosholu ba mathata le tšebeliso ea methapo ea kelello (ka mantsoe a mang, papali ea chelete e sa pheleng) joalo ka pheletso e feteletseng ea papali ea papali ea chelete e sebelisitsoeng lithutong tse fetileng (8, 9).

Leha lithuto tsa pejana li bontšitse khokahano lipakeng tsa papali ea chelete ea ho becha le lefu la kelello la DSM-IV Axis I (1, 2, 10, 11), sebopeho sa tlhaiso-leseling se sebelisitsoeng lithutong tseo se ile sa sitisa bokhoni ba ho theha tatellano ea nakoana lipakeng tsa papali ea chelete le mafu a kelello, leha e le hore e 'ngoe ea lithuto tseo e sebelisitse lilemo tsa ho qala ho theha tatellano ea nakoana (2). Ntle le moo, hobane ho becha ho sa ts'oaneng ho tsamaisana le ts'ebetso e sa sebetseng (12, 13), boleng ba bophelo bo fokotsehileng (12-14, maemo a itseng a kalafo12), le litefiso tse phahameng tsa ho kopana le liketsahalo tse sithabetsang tsa bophelo tse kang ho hloka mosebetsi, tlhalo le ho putlama (7), lintlha tsena li fumanoe hape li amanang le mathata a Axis I (15-17). Ka hona, hobane lintlha tsena li ka ba le tšusumetso ho papali ea chelete ea ho becha le likotsi tsa Axis I, ho bohlokoa hore mabaka ana a ferekanyang a laoloe bakeng sa ho lekola likamano lipakeng tsa ho becha le mathata a kelello. Ho fihla joale, lithuto tse sa sebetsanang le maemo li sa fetoha bakeng sa lintlha tsena tsa bohlokoa (1, 2, 10). Ho tlatsa likheo tsena, re ne re ikemiselitse ho lekola mokhatlo oa mathata a bophelo bo botle ba lilemo tsa ho qetela tsa ho tsofala le boemo ba mathata a kelello a Axis I nakong ea ho latela lilemo tsa 3 hamorao, kamora ho lokisa maemo a bophelo a amanang le maemo a bophelo, maemo a bongaka, boleng bo amanang le bophelo, le liketsahalo tse sithabetsang tsa bophelo.

LISEBELISOA LE MEKHOA

Palo ea batho ba ithutang

Re sebelisitse data e tsoang ho maqhubu a 1 (2000â € “2001) le 2 (2004â €“ 2005) ea National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Wave 1 ea NESARC e hlahlobile sampole ea baemeli ba baahi ba 43,093 ba lilemo li 18 kapa ba baholo ba lulang malapeng a US, ba feta batho ba batšo le ba Spain le bacha ba baholo ba nang le lilemo tsa 18â €18, 19). Kamora ho kenyelletsoa ha ba arabelitsoeng ba neng ba sa tšoanelehe bakeng sa tlhahlobo ea wave ea 2 hobane ba ne ba hlokahetse (n = 1,403), o ne a tlositsoe kapa a holofetse kelellong kapa 'meleng (n = 781), kapa ba ne ba sebetsa ka mafolofolo mabothong a hlometseng nakong eohle ea ho latela (n = 950), wave 2 e ile ea etsoa lilemo tsa 3 hamorao; tekanyo ea karabelo e ne e le 86.7%, e bonts'a lipuisano tsa sefahleho tsa sefahleho sa 34,653. Lintlha tsa Wave 2 li ne li le boima ho bontša litšobotsi tsa moralo oa NESARC, akhaonto bakeng sa ho fetisa, ho se arabele, le ho ba teng ha wave ea 1 NESARC ea ts'ebeliso ea lisebelisoa kapa ts'ebeliso ea kelello kapa mafu a kelello; phetoho ena e entsoe maemong ohle a ntlo le a motho ka mong (20). Lintlha tse boima li ile tsa fetoloa hore e be moemeli oa baahi ba United States mabapi le maemo a moruo a amanang le Census ea 2000 ea United States. Ka lebaka la boleng bo haellang ba mefuta e meng e hlahlobiloeng thutong ena, re tsepamisitse maikutlo thutong ea 33,231 tlhahlobisong ena.

Mehato

Tlhahlobo ea DSM-IV ea likotsi tsa mafu a kelello e ile ea hlahlojoa le Alcohol Use Disorder and Associated Disability Interview scheduleâ € ”DSM-IV Version (AUDADIS-IV) (21), wave wave 2 (22), e ntlafalitsoeng hore e sebelisoe ke bafuputsi ba marang-rang ba koetlisitsoeng. Mathata a kelello a Axis I a ile a hlahlojoa ka mokhoa o ts'oanang le maqhubu 1 le 2 liphetolelo tsa AUDADIS-IV, ntle le liforeimi tsa nako. Nako ea bophelo le 12 ea khoeli le khoeli ea ho hlahloba mafu a mafu a kelello e fumanoe ho wave 1, ha 12-khoeli le 3 ea selemo le selemo ea ho sibolla mathata e ne e baloa ka wave 2. Bohlohlelong ba liketsahalo tsena, ke ba arabelitsoeng feela ba neng ba sena tšoaetso ea lefu leo ho buuoeng ka lona qalong ba kenyellelitsoeng tlhahlobisong, 'me phetoho e ka sehloohong e neng e le 3 ea selemo sa ho fumanela mofets'e bothata ba wave 2. Ha ho melao ea maemo a hloahloa e sebelisitsoeng ho maqhubu ana ka bobeli, ntle le ha ho fumanoe hore maemong a holimo ho ne ho sebelisoa lefu la khatello ea maikutlo le la ho ferekana kelellong.

Ka maqhubu a 1 le 2, mathata a maikutlo a mantlha a DSM-IV a kenyelletsa ho sithabela ho hoholo ha khatello ea maikutlo, bokuli ba dysthymic, le bipolar (I kapa II). Mathata a ho tšoenyeha a kenyeletsa pherekano ea ho tšoha (e nang le kapa agoraphobia), phobias ea maemo a bophelo le e tobileng, lefu la ho tšoenyeha ka kakaretso le khatello ea maikutlo ea posttraumatic khatello ea maikutlo (PTSD). Mekhoa ea AUDADIS-IV e sebelisitsoeng ho fumana mathata ana e hlalositsoe ka botlalo libakeng tse ling (21, 23-28). Litšepiso tsa liteko tsa “test-retest” (boleng ba kappa) bakeng sa tlhahlobo ea AUDADIS-IV ea mathata a ho feto-fetoha ha maikutlo le khatello ea maikutlo bathong ka kakaretso le litlhophiso tsa kliniki li simoloha ho tloha ho le letona ho isa ho tse ntle (κ = 0.40â € “0.77) (29-31). Ho nepahala ha Convergent ho ne ho le molemo ka ho fetisisa bakeng sa tlhahlobo ea maikutlo le maikutlo ohle (21, 24-26, 28, 32-34), mme lits'oaetso tsena li bonts'itse tumellano e ntle (κ = 0.64â € “0.68) le reappraisals tsa psychiatrist (29).

Potso e pharaletseng ho AUDADIS-IV e koahetse litekanyetso tsa DSM-IV tsa ts'ebeliso ea nicotine, joala le tlhekefetso e amanang le lithethefatsi, le ts'ehetso ea lihlopha tsa 10 tsa dintho (amphetamines, opioids, sedatives, tranquilizer, cocaine, inhalants / sol sol, hallucinogens, cannabis , heroin, le lithethefatsi tse ling). Tlhahlobo ea tlhekefetso ea DSM-IV e hlokometse ho ba teng ha mekhoa ea tlhekefetso ea 1 kapa ho feta ha 4, athe tlhahlobo ea ts'ebetso ea ts'ehetso ea DSM-IV e ne e batla hore 3 kapa ho feta tsa mekhoa ea ts'ehetso ea 7 li fihlelloe. Ho tšepahala ha liteko tsa tlhahlobo ea tšebeliso ea litheko tsa AUDADIS-IV ho fumanoe ho le molemo ho li-sampuli tse hantle tsa κ = 0.70â € “0.91”29-31, 35-37). Phetoho e ntle, khethollo, le ho etsa bonnete ba litekanyetso tsa tšebeliso ea litheko tsa AUDADIS-IV li ngotsoe hantle (38-41), ho kenyelletsa le litokomane ho World Health Organisation / National Institutes of Health International Study on Reliability and Validity (42-47), moo ho buuoang hape ka tliliniki e bontšitse bonnete bo nepahetseng ba tlhahlobo ea tahi le ts'ebeliso ea lithethefatsi tsa DSM (κ = 0.54â € “0.76) (29, 42).

Lintlha tse mabapi le hore na moqosuoa o ne a arolelitse papali ea chelete e fumanoe a sebelisa 10 DSM-IV tlhahlobo ea tlhahlobo ea tlhahlobo ea ho becha ha pelo. E lumellana le lithuto tse fetileng u sebelisa lintlha tsa NESARC (10, 48-51), tlhahlobo ea 12 ea khoeli le khoeli ea tlhahlobo ea botšehali e hloka hore moqosuoa a kopane le bonyane mekhoa ea 3 selemong se fetileng le ho tlaleha ho becha bonyane makhetlo a 5 selemong se fetileng. Bohle ba arabelitsoeng ba neng ba sa khetholloe ka ho becha ba ne ba khethollotsoe ka mokhoa oa papali ea chelete, ho kenyeletsoa ba neng ba sa ka ba becha ka nako eohle ea bophelo ba bona. Ho lumellana ha kahare ho lintho tsohle tsa matšoao le lits'oants'o tsa ho becha ha methapo ea methapo li ne li le ntle haholo, 'me ho ile ha thehoa bonnete ba sekala (1).

Meetso ea Sociodemographic, ho kenyelletsa thobalano, lilemo, boemo ba lenyalo, boemo ba thuto, morabe / morabe, chelete ea ntlo le boemo ba mosebetsi ho wave 1 li kentsoe mefuteng eo. Ntle le moo, maemo a bongaka, bophelo bo amanang le bophelo bo botle, le liketsahalo tse sithabetsang tsa bophelo ho wave wave 1 le tsona li kentsoe e le lintho tse nyahamisang mehlaleng ena. NESARC e hlahlobe ho ata ha selemo se fetileng sa maemo a bongaka a 11: arteriosulinosis, khatello ea mali, cirrhosis, maloetse a mang a sebete, angina, tachycardia, infarction ea myocardial, mafu a mang a pelo, seso sa ka mpeng, gastritis le ramatiki. Babuelli ba ile ba botsoa hore na ngaka kapa setsebi se seng sa bophelo bo botle se fumane boemo boo. Boleng ba bophelo bo amanang le bophelo bo ile ba hlahlojoa ho sebelisoa mokhoa o mokhuts'oane oa 12 Health Surveyâ € ”Version 2 (SF-12) (52). Litekanyo tsa kakaretso ea likarolo tsa bophelo bo botle ba 'mele le kelello SF-12 li baliloe. Lethathamo la liketsahalo tse 12 tsa morao-rao tse sithabetsang bophelong (tse etsahetseng selemong se fetileng pele ho leqhubu la 1) le tsona li kenyelelitsoe. Liketsahalo tse 12 tse sithabetsang bophelong e bile: lefu la setho sa lelapa kapa motsoalle ea haufi; ho kula haholo kapa ho lemala setho sa lelapa kapa motsoalle ea haufi; ho fallela ntlong e ncha kapa ho ba le litho tse ncha tsa lelapa; ho lelekoa mosebetsing kapa ho lelekoa mosebetsing; ho se sebetse le ho batla mosebetsi ho feta khoeli e le 'ngoe; ho ba le bothata le mookameli kapa mosebetsi-'moho; ho ba le phetoho mosebetsing, boikarabelong ba mosebetsi, kapa lihora tsa mosebetsi; ho arohana kapa ho hlalana kapa ho qhala kamano e tsitsitseng; ho ba le bothata le moahisani, motsoalle, kapa mong ka uena; ho ba le mathata a maholo a lichelete; ho kena mathateng le mapolesa, ho ts'oaroa, kapa ho isoa teronkong (ekaba mo nkang karolo kapa setho sa lelapa); le ho ba lehlatsipa la botlokotsebe (ekaba monkakarolo kapa setho sa lelapa).

Mekhoa ea lithapo

Liperesente tse boima li ne li kopitsoa ho fumana litšobotsi tsa sechaba sa batho ba arabelang ka ntle le ho se be le papali ea chelete. Mefuta ea maemo a ho ikhopola e ne e etselitsoe ho lekola tloaelo ea papali ea chelete e litšila le litšobotsi tsohle tsa sechaba. Ntle le moo, mefuta ea 5 ea mekhoa ea ho khutlisa e sebelisitsoeng e ne e sebelisetsoa ho lekola mekhatlo lipakeng tsa papali ea chelete e fetileng ea selemo le ts'ebetso ea maikutlo, ho tšoenyeha le mathata a tšebeliso ea lithethefatsi nakong ea ho latela ha 3 ea lilemo tse latelang tsa wave 2 (ke hore, ke ba arabelang feela ba neng ba sena tšoaetso ea bophelo bohle ba mofets'e eo ho buuoang ka lona ho wave 1 ba kenyellelitsoeng ho tlhahlobo). Mefuta ea pele e fetotsoe feela bakeng sa likarolo tsa boiketlo ba sechaba tse lekiloeng thutong ena. Ntle le litsobotsi tsa sechaba le tlhahlobo ea bophelo ba pherekano eo ho buuoang ka eona, mehlala ea bobeli, ea boraro le ea bone e boetse e ntlafalitsoe bakeng sa ho ba teng ha maemo a bongaka a 11, SF-12 lintlha tsa kakaretso tsa bophelo bo botle ba kelello le kelello le liketsahalo tsa bophelo tse sithabetsang tsa 12, ka ho latellana . Moetso oa ho qetela ka nako e ts'oanang o kenyelletsa li-covariate tsohle tse boletsoeng ka holimo.

Lintlha li ile tsa hlahlojoa le SUDAAN 9.0 (Research Triangle Institute, Research Triangle Park, North Carolina), lenaneo la software le sebelisang tatellano ea tatellano ea Taylor ho hlophisa litlamorao tsa moralo oa mokhoa o rarahaneng oa mehlala ea NESARC. Ho ikamahanya le liteko tse ngata tsa lipalo, re beha boemo ba bohlokoa bakeng sa liteko tsohle ho P <0.01 ho fokotsa phoso ea mofuta oa I le ho eketsa menyetla ea hore litlamorao li ka phetoa lithutong tse tlang. Liphoso tsohle tse tloaelehileng le likhaohano tsa 99% tsa ho itšepa li fetotsoe bakeng sa litlamorao tsa moralo oa leqhubu la 2 NESARC sampole.

LIPOTSO

Keketseho e akaretsang ea papali ea chelete e sa sebetseng thutong e ne e le 0.60% (99% karabelo ea nako: 0.51, 0.71). Keketseho ea papali ea chelete e arohaneng har'a ba arabetseng banna le basali e ne e le 0.82% (99% karohano ea ho itšepa: 0.66, 1.02), le 0.40% (99% karohanyo ea kholiseho: 0.30, 0.53), ka ho latellana. Lethathamo 1 e fana ka kabo ea litaba tse fapaneng tsa sechaba har'a batho ba nang le papali ea chelete le ntle le ho ba sieo. Boitlhotlhollo ba thepa bo senotse lipalo tsa lipalo lipakeng tsa lipalo pakeng tsa batho ba sa tsubeng le ba sa tsotelleng bakeng sa thobalano, thuto le morabe / morabe. Ho ba mosali ho fokolitse menyaka ea papali ea chelete. Mabapi le boemo ba thuto, ho ba le thuto ea univesithi, ha ho bapisoa le ho ba le thuto e tlase ho sekolo se phahameng, ho fokolitse mathata a papali ea chelete. Kamora nako, ho ba setho sa Maspanishe ka ho ba mosoeu ho ne ho boetse ho amahanngoa le menahano e fokotsehileng ea papali ea chelete e ngata. Ha ho fapana lipalo li ne li sa fumanoe bakeng sa lilemo, boemo ba lenyalo, chelete ea lelapa, kapa boemo ba mosebetsi.

Tafole 1.  

Litšobotsi tsa Sechaba sa Batho ba nang le papali ea chelete le e se nang letho ea selemong se fetileng (n = 33,231), Patlisiso ea Sechaba sa Epidemiologic mabapi le Joala le Maemo a amanang, 2000-2005a

Lethathamo 2 e hlahisa litekanyetso tse sa lumellaneng tsa kamano pakeng tsa papali ea chelete e fetileng ea lilemo tse fetileng, joalo ka ha ho lekantsoe le wave 1, le ts'oaetso ea mafu a kelello a Axis I nakong ea ho latela 3. Kamora phetoho bakeng sa litšobotsi tsa sechaba tse lekantsoeng ho wave 1, batho ba tlalehileng lipapali tsa ho becha tse fetileng tsa selemo se fetileng ba ne ba le monyetla o moholo oa ho ba le ho qaleha hoa bothata bofe kapa bofe ba kelello ba Axis I, ho ferekana ha maikutlo, ho ferekana kelellong, pherekano e akaretsang ea PTSD, , bokuli ba tšebeliso ea joala, le bothata ba ts'ebeliso ea lino tse tahang nakong ea tlhahlobo ea lilemo tsa 3. Motsoako oa papali ea chelete e ferekaneng le lefu la ho ferekana o fetohile o se nang thuso ka mor'a phetoho e eketsehileng bakeng sa ho ba teng ha maemo a bongaka a 11 ho wave 1. Likamano tse bohlokoa tsa papali ea chelete e ferekaneng le lefu la ho feto-fetoha ha maikutlo la boloi le khatello ea tšebeliso ea lithethefatsi li ne li se li sa bohlokoa ka mora litokiso tse ling tsa kakaretso ea kakaretso ea bophelo bo botle ba kelello le kelello ba SF-12.

Tafole 2.  

Keketseho ea Lilemo Tse Tharo ea DSM-IV Axis I Mathata a kelello le litekanyetso tse amanang le ona, ka Boemo ba Papali ea Chelete e Ntle (n = 33,231), Patlisiso ea Sechaba sa Epidemiologic mabapi le Joala le Maemo a amanang, 2000-2005

Ha re fetola mokhoa oa ho thulana le liketsahalo life tse sithabetsang tsa bophelo ba 12 selemong se ka pele ho wave 1, likamano lipakeng tsa papali ea chelete e nang le mathata le bothata bofe kapa bofe ba Axis I, botolar, le bothata bofe kapa bofe ba tšebeliso ea lithethefatsi ha li sa na letho. Mefuteng ea hoqetela e tšoanang ka nako e le ngoe ea ho feto-fetoha ha maemo a sechaba, ho ba teng ha maemo a bongaka a 11, lintlha tse akaretsang tsa bophelo bo botle ba kelello le kelello tsa 12, le liketsahalo tse sithabetsang tsa bophelo ba 12, papali ea chelete e arohaneng e lutse e amana haholo le bothata bofe kapa bofe ba ho feto-fetoha ha maikutlo, pherekano e akaretsang, PTSD , mathata a ts'ebeliso ea joala, le ho ts'ebella joala.

TŠOHLOA

Lithuto tse 'maloa tse arolelanang likarolo tsa marang-rang li fumane setsoalle se bohlokoa pakeng tsa ho becha hampe le ho ts'oaroa ke DSM-IV Axis I mafu a kelello (1, 2, 10, 11, 51). Patlisiso ea hajoale ke pale hobane e eketsa kutloisiso ea rona mabapi le komorbidity e sa sebetseng ea ho becha ka tšebeliso ea moemeli oa naha, ea malelele, ea moralo oa boithuto ha ka nako e tšoanang ho ntse ho etsoa liphetoho tse 'maloa tse makatsang tse tsebahalang tse amanang le mathata a papali ea chelete le mafu a kelello. Liphetho tsa bohlokoa ho tsoa thutong ena ke hore 1) papali ea chelete e fetileng ea 1 e ne e amana le menyetla e mengata ea likotsi tsa mafu a kelello a Axis I nakong ea ho latela 3 lilemo hamorao le 2) likamano tsa bohlokoa li ile tsa sala li bohlokoa kamora phetoho e tšoanang lipakeng tsa lintho tse ka 'nang tsa ferekanya, ho kenyeletsa lintlha tsa sechaba, maemo a bongaka, ho fokotsa bophelo bo amanang le bophelo le liketsahalo tse sithabetsang tsa bophelo.

Phuputsong ea morao tjena, papali ea chelete e sa sebetseng e mpa e boletse liketsahalo tsa mafu a kelello - ka ho khetheha, lefu la ho ferekana kelellong, ho tšoenyeha ho hoholo, PTSD, ts'ebeliso ea tšebeliso ea joala, le bothata ba ho ts'epa joala, le bothata bofe kapa bofe ba Axis I. tšebeliso ea lithethefatsi. Ha ho na le mekhelo e mengata (tlhekefetso efe kapa efe ea Axis I, ts'ebetso efe kapa efe ea ts'ebeliso ea lithethefatsi, le lefu la ho ferekanya kelello), likamano tsena tsa bohlokoa li ile tsa sala li le teng kamora hore re lumellane ka tatellano bakeng sa mefuta eohle e ferekanyang; mefuta e ferekanyang e ne e sa ikarabelle ka phapang e teng likamanong tsena mme ba sitoa ho hlalosa kamano pakeng tsa ho becha ka phoso le ketsahalo ea mafu a kelello a Axis I. Liphumano tsena li fana ka maikutlo a hore ho ba teng ha papali ea chelete e senyehileng ho ka ba le monyetla oa ho bolela liketsahalo tsa khatello ea maikutlo nakong e tlang, ho tšoenyeha ka kakaretso, PTSD, ts'ebeliso ea joala kapa ts'ebeliso ea maikutlo mme ho na le monyetla o fokolang oa ho etella khatello ea maikutlo, dysthymia, ho tšoha ha letsoalo, phobia e ikhethileng, phobia e ikhethang. , ts'ehetso ea nicotine, le mathata a ts'ebeliso ea lithethefatsi. Litlhaloso tse ka bang teng bakeng sa lipaterone tsena liphumatsong li feta tekano ea tlhaiso-leseling ea hona joale, empa lipatlisiso tsa nako e tlang molemong oa moelelo ona e ne e tla ba tse khahlisang.

Liphumano tsena li tšoana le tsa patlisiso e fetileng mabapi le kamano ea nakoana lipakeng tsa papali ea chelete ea ho becha le mathata a Axis I a sebelisitseng tlhaiso-leseling ka tlhaiso-leseling e mabapi le lilemo tsa ho qala (2). Phuputsong eo, ho ile ha fumaneha hore bothata ba papali ea chelete bo boletse esale pele ka lefu la ho ferekana, PTSD, bothata bofe kapa bofe ba ho tšoenyeha, joala kapa ts'ebeliso ea lithethefatsi, ts'ebeliso ea nicotine, ts'ebeliso efe kapa efe ea ts'ebeliso ea lithethefatsi, le tlokotsi efe kapa efe kamora phetoho ea lilemo, thobalano le morabe / morabe. taba ea hore liphetho tsena li lokela ho hlalosoa ka hloko ka lebaka la ts'episo ea tlhaiso-leseling ea tlhaiso-leseling. Leha maemo a akaretsang a bonoa pakeng tsa thuto e fetileng (2) le liphumano tsa morao-rao, thuto ea hajoale e ntlafatsa kutloisiso ea rona ea kamano pakeng tsa papali ea chelete e litšila le likotsi tsa Axis I ka tšebeliso ea lintlha tse telele, tse ka lebelloang, kenyelletso ea mefuta e mengata e ka 'nang ea ferekanya, le tlhahlobo ea tahi le tšebeliso ea lithethefatsi ka thoko.

Haholo-holo kamano e lipakeng tsa likamano tsa botona le botšehali tse amanang le tšebeliso ea joala e ne e le matla ka tlhaho maemong ohle a liketsahalo. Leha ho le joalo, kamano ea bohlokoa pakeng tsa papali ea chelete e senyehileng le mathata a ts'ebeliso ea lithethefatsi ha a ka a fumanoa mefuteng efe kapa efe. Liphumano tsena li lebisa tlhokomelo ho bohlokoa ba ho ithuta joala le tšebeliso ea lithethefatsi ka lihlopha tse fapaneng ho fapana le ho hlahloba feela karolo e pharaletseng ea tšebeliso ea lithethefatsi. Likamano lipakeng tsa papali ea chelete e jeleng setsi le joala le tšebeliso ea lithethefatsi e kanna ea se tšoane, e leng le bohlokoa lipakeng tsa melaoana ea bophelo bo botle mabapi le melao ea papali ea chelete le tšebeliso ea joala. E kanna eaba tšebeliso ea joala hangata e kopane hangata le papali ea chelete ha e bapisoa le tšebeliso ea lithethefatsi, hobane joala ke sesebelisoa sa molao hangata se rekisoang libakeng tsa ho becha. Libaka tse ling tsa papali ea chelete li lumella ho jara joala ha papali ea chelete le libaka tse ling li thibela tšebeliso ea lino tse tahang libakeng tse natefiloeng ka ho becha, li lumella motho ea bechang hore a noe joala pele kapa ka mor'a ho becha. Khokahano e kopaneng ea ho becha le joala e kanna ea hlalosa hore na hobaneng ho becha ho sa ts'oaneng ho ne ho hokahana feela le mathata a mangata a tšebeliso ea tšebeliso ea lino tse tahang eseng likotsi tsa ts'ebeliso ea lithethefatsi. Mokhahlelong o sebelisang lithethefatsi o mong le o mong o ka se khone ho lemoha phapang e teng likamanong tsena.

Ho latela pono ea bophelo bo botle ba sechaba, liphumano tse tsoang thutong ena li bohlokoa hobane li bontša hore mathata a papali ea chelete a ka lebisa ho hlaheng hamorao ho ba le mathata a itseng a kelello. Ho lahleheloa ke taolo ea boits'oaro ba motho le ho holisa papali ea chelete e sa sebetseng ho ka baka khatello ea maikutlo bophelong ba motho. Batho ba nang le mathata a ho becha hangata ba tlaleha mathata a kang ho senya chelete e ngata ho becha ho feta kamoo ho neng ho reriloe, ho sitoa ho fokotsa kapa ho tlohela papali ea chelete, le ho becha ho lebala ka mathata kapa maikutlo a tepeletseng maikutlo, mme hangata ba tlaleha hore papali ea chelete e bakile mathata ka metsoalle le ba lelapa (53). Matšoenyeho a amanang le ho becha ho sa laoleheng a ka baka maikutlo a bohlokoa a amanang le ho tšoenyeha a ka lebisang ho ketsahalo e itseng ea maikutlo, ho tšoenyeha le mathata a tšebeliso ea lithethefatsi. Ka mokhoa o ts'oanang, ho batho ba bang ho becha e ka ba mokhoa o sa sebetseng hantle oa ho sebetsana le mathata a maikutlo, ho kenyelletsa maikutlo a sithabetsang kapa a tšoenyehileng, a fetisang mathata le matšoao, a lebisang ho litekanyetso tsa likopano tsa mafu a mang a kelello a Axis I.

Patlisiso e tsoelang pele mabapi le kamano ea nakoana pakeng tsa papali ea chelete e kopaneng le Axis I mafu a kelello e ea hlokahala hobane ho ka etsahala hore mathata a kelello a Axis I a ka hlaha pele kapa ka nako e tšoanang le mathata a papali ea chelete. Leseli le lenyenyane le fumaneha mabapi le mokhatlo oa nakoana oa kamano ena (54). Mohlala, phuputso e 'ngoe ea morao-rao e fumane hore khatello ea maikutlo e ne e le ntho e ka etsahalang pele ho nts'etsopele ea mathata a ho becha joaloka kamora moo (55), ho fana ka maikutlo a hore batho ba bang ba ka sebelisa ho becha e le mokhoa o sa sebetseng hantle oa ho thusa ho imolla letsoalo, ha ba bang ba ka nyahama ka lebaka la mathata a bona a papali ea chelete. Kessler el al.'s (2) Phuputso ea 2008 e bonts'itse hore ntle le bothata ba ho becha ho bolela esale pele mathata a mang a maikutlo, matšoenyeho le ts'ebeliso ea lithethefatsi maemong a mang, papali ea chelete ea papali ea chelete le eona e fumanoe e hlaha kamora mafu a mangata a kelello a DSM-IV, ho kenyeletsoa matšoenyeho, maikutlo, taolo ea tšusumetso le lithethefatsi. mathata a ts'ebeliso, bakeng sa batho ba bang. Ho hlahlojoa kamano e iphetang ea mathata a kelello a Axis I le papali ea chelete e sa sebetseng ho ne ho sa khonehe thutong ea hajoale, hobane papali ea chelete e ile ea lekoa feela motheong oa mantlha. Ena ke moeli o hlokomelehang oa thuto ea hajoale.

Matla a lipatlisiso tsa hona joale a kenyelletsa tšebeliso ea sampole e kholo, e emelang naha; moralo oa thuto e telele le e lebelletsoeng; mekhoa ea lipotso tsa sefahleho le sefahleho; ho kenyelletsoa ha lisebelisoa tsa tlhahlobo tse tšepahalang le tse sebetsang; le phetoho e tšoanang ka nako bakeng sa lintho tse 'maloa tse ka' nang tsa ferekanya. Leha ho le joalo, lipatlisiso tse fumanoeng boithuto ba hona joale li lokela ho nahanoa ka meeli ea meeli e 'maloa ea bohlokoa. Taba ea mantlha, liphatlalatso tsohle tsa mafu a kelello li entsoe ka tlhahlobo e tšepahalang e hlophisitsoeng e entsoeng ke bafuputsi ba thuto ba rutehileng, leha ho le joalo mokhoa ona oa tlhahlobo o kanna oa se lumellane le tlhahlobo ea tlhahlobo e entsoeng ke ngaka e nang le boiphihlelo. Taba ea bobeli, maemo a bongaka a ne a ipapisitse le litlaleho tsa bongaka tsa bongaka 'me li sa netefatsoe ho tsoa mehloling e ikemetseng. Le ha ts'ebetso ena e sebelisitsoe ho lipatlisiso tse ling tsa papali ea chelete (56), ho ka etsahala hore batho ba bang ba tlalehe boemo ba bongaka bo neng bo ke ke ba tšoana le tlhahlobo ea ngaka. Ntle le moo, ho tlaleha maemo a mang ho kanna ha etsahala haeba moqosuoa a na le boemo boo empa a e-so fuoe lefu la ngaka. Maemo a bongaka a XNUMX a ile a hlahlojoa ho data ena, empa sena ha se bontše lenane le felletseng. Taba ea boraro, liketsahalo tse 'maloa tsa khatello ea bophelo li ile tsa lekoa ho data ea hajoale, empa lenane la liketsahalo tse sithabetsang tsa bophelo ha le nkoe le felletse. Ea bone, tlhahlobo ea papali ea chelete e senyehileng motheong oa mantlha ha ea ka ea lumella tlhahlobo ea kamano e phetoang ea mathata a kelello ea Axis I le ketsahalo kapa papali ea chelete e phehellang. Kamora nako, litlhahlobo tsa bophelo bohle ba mafu a kelello li ile tsa hlahlojoa motheong oa mantlha e le e 'ngoe ea li-covariate tse sebelisitsoeng litlhahlobong tsa rona, empa litlhahlobo tsa bophelo bohle li ne li itlaleha ka mokhoa o ikhethileng mme ka hona li ne li le bonolo ho hopola leeme.

Liphuputso tse tsoang lipatlisisong tsa hajoale li na le litlamorao tsa bohlokoa tsa bongaka. Liphetho tsa phuputso ena li fana ka bopaki ba hore papali ea chelete e senyehileng e ka lebisa ketsahalong le mathata a kelello a Axis I a sa feleng le hore likamano tsena tsa bohlokoa li ke ke tsa hlalosoa ke maemo a bophelo ba sechaba, maemo a bongaka, bophelo bo fokotsehileng bo amanang le bophelo, kapa liketsahalo tse sithabetsang bophelong. Bafani ba kalafo ba hloka ho lekola bakuli ba papali ea chelete bakeng sa mathata a maikutlo, matšoenyeho le ts'ebeliso ea lithethefatsi le ho lekola matšoao bakeng sa kholo e ka bang teng ea maemo a morao a comorbid. Hobane mathata a papali ea chelete le comorbid Axis I mafu a kelello a ka hokahanngoa, ho ka etsahala hore ts'ebetso ea kalafo e ka fokotsoa haeba mathata a papali ea chelete a ne a phekoloa ka thoko ha matšoao a mang a kelello kapa mathata, ho kenyeletsoa maikutlo, matšoenyeho le mathata a ts'ebeliso ea lithethefatsi a ne a le teng. Bakeng sa batho ba bang, papali ea chelete e ka baka matšoao a ba amang kapa a ho tšoenyeha kapa takatso ea ho noa joala ho sebetsana le mathata. Boiteko ba ho kenella ho sebetsana le boits'oaro ba papali ea chelete u le mong ntle le ho sebetsana le matšoao a amanang le ona, matšoao a ho tšoenyeha kapa tloaelo ea ho noa ho ka baka katleho ea kalafo. Ho bohlokoa ka mokhoa o ts'oanang, ho a hlokahala ho hlahisa mekhoa ea kalafo e ka lumellanang le litlhoko tsa bophelo ba kelello ba motho le ho lekola ka matla kalafo ena bakeng sa katleho e netefalitsoeng a sebelisa mekhoa e thehiloeng bopaking.

lumela hore baa fokola

Mekhatlo ea lingoli: Lefapha la Mosebetsi oa Sechaba le Tsamaiso ea Sechaba, Univesithi ea Hong Kong, Hong Kong, China (Kee-Lee Chou); le Mafapha a Saense ea Bophelo ba Sechaba, Psychiatry, le Saense ea Boiketlo ba Lelapa, Univesithi ea Manitoba, Winnipeg, Manitoba, Canada (Tracie O. Afifi).

National Epidemiologic Survey on Alcohol and Related maemo (NESARC) e ile ea etsoa mme ea tšehetsoa ke National Institute on Alcohol Abuse and Alcoholism (NIAAA), ka tšehetso e tlatselletsang e tsoang ho Setsi sa Naha sa Ts'ebeliso e Mpe ea Lithethefatsi.

Bangoli ba leboha NIAAA le baemeli ba masimo a US Census Bureau ba tsamaisitseng lipuisano tsa NESARC mme ba etsa hore liphetho li fumanehe.

Dr. Kee-Lee Chou o ne a na le phihlello e felletseng ea datha tsohle thutong mme o nka boikarabello bakeng sa botshepehi ba datha le ho nepahala ha tlhahlobo ea data.

Khohlano ea khahlano: ha ho ea phatlalalitsoeng.

lenaane-foko

khutsufalitsoeng

AUDADIS-IVTlhatlhobo ea Ts'ebeliso e Mpe ea Joala le Tlhahlobo ea Lipuisano e amanang le Bokooa-DSM
DSM-IVBuka ea ho hlahloba le ea Statistical of Disabilities, Khatiso ea bone
NESARCPatlisiso ea Sechaba ea Epidemiologic mabapi le Joala le Maemo a amanang
PTSDposttraumatic khatello ea kelello
SF-12Lipatlisiso tse Ntle tsa Bophelo ba 12-Version 2

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