Front Psychiatry. I-2018 Oct 16; 9: 497. doi: 10.3389 / fpsyt.2018.00497.
I-Valero-Solís S1, IGranero R2,3, I-Fernández-Aranda F2,4,5, USteward T2,4, I-Mestre-Bach G2,4, Mallorquí-Bagué N2,4, UMartín-Romera V6, Aymamí N4, I-Gómez-Peña M4, Del Pino-Gutiérrez A7, U-Baño M4, Moragas L4, I-Menchón JM4,5,8, UJiménez-Murcia S2,4,5.
abstract
Ingemuva futhi ihlose: Ukwanda kokwanda kokulutha kokuziphatha emhlabeni wonke kuholele ekukhuleni ocwaningweni lwe-etiological lomnikelo othize wezinto ezinobungozi / zokuvikela kulezi zinkinga. Inhloso yalolu cwaningo kwakuwukuhlola iqhaza elihlobene nobulili beziguli, ubudala bokuphazamiseka kanye nobude besifo kuphrofayili yomtholampilo yokulutha kokuziphatha.
Izindlela: Isampula yethu ifake iziguli ezifuna ukwelashwa ezitholakala zinenkinga yokugembula (GD, n = 3,174), ukuphazamiseka kokugembula kwe-inthanethi (IGD, n = 45), ukuthenga okuphoqayo (i-CB, n = 113), kanye nomlutha wezocansi (SA, n = 34).
Ezenye: Iphethini yezinhlangano phakathi kokuguquguquka okuzimele nemiphumela yayihlobene kakhulu nesihlokwana sokuluthwa kokuziphatha: (a) kokuqala kokuqala kwale nkinga kuhlobene nobunzima be-GD, ngenkathi ukuqala kwe-GD-kwabesifazane ekuqaleni kwakuxhunyaniswa nokufuna okusha ; (b) kubantu be-IGD-men, ukuqala kwesikhathi kuhambisane nobunzima bokuthi umlutha, isimo sengqondo esibi ngokwengqondo, kanye nokuvinjezelwa okuphezulu kokulimala kanye namazinga wokuzenzisa; (c) kwabesifazane be-CB, ukuqala kwesikhathi kwakuhlobene nezinga lokuncika lomvuzo ophakeme kanye namazinga aphansi wokuzithoba, futhi isikhathi eside sibikezela izikweletu eziphakeme kakhulu; okwenzelwe i-CB-men, ukuqala kokuqala nesikhathi eside kuhlanganiswe nezimpawu eziphakeme zokugwema ukulimala, ukuziqondisa, ukuzithoba, kanye nokubambisana; kanye (d) nokwabesilisa base-SA, ukuqala sekwedlule isikhathi eside okuhambisana nobunzima obukhulu bokuphazamiseka.
Ingxoxo neziphetho: Lokhu okutholakele kufanelekile ekuthuthukiseni izinhlelo zokuvimbela nokwelashwa eziqondene nokuluthwa okuhlukile kokuziphatha.
KEYWORDS: iminyaka; umlutha wokuziphatha; ukuthenga okuphoqayo; ukuphazamiseka kokugembula; inkinga yokugembula kwe-inthanethi; umlutha wobulili
I-PMID: 30386263
I-PMCID: I-PMC6198171
I-DOI: 10.3389 / fpsyt.2018.00497
Isingeniso
Imilutha yokuziphatha okuhle ifaka iqembu lezimo ezimangazayo elibonakaliswa ukuphoqelelwa ukuthi lihlanganyele ekuziphatheni okuzuzisa okwesikhashana, okuphathelene nezinto ezingadalela ukuphikelela yize ulwazi lwemiphumela emibi (1-3). Ngesikhathi salezi zinkinga, abantu balahlekelwa ukulawula kokuziphatha ngokweqile noma okuyinkinga, kube nomphumela obalulekile emndenini, emsebenzini nasezindaweni zenhlalo zezimpilo zabo (4, 5). Esikhathini sokuqala kwesimo, amazinga aphakeme wokuphoqelela kuhloselwe ukuthola umvuzo ngokushesha (ukuqiniswa okuhle), kepha phakathi nalesi simo, indlela yokuziphatha eyimilutha iba yaphoqelelwa futhi ihlose ukunciphisa izimo ezingokomzwelo ezingezinhle (ukuqiniswa okungalungile) (6). Ngaphakathi kwalolu cwaningo lokucwaninga, kubuye kwaqokwa ukuthi ukuhlukaniswa kwezigaba kanye ne-transdiagnosis kungakuchaza kangcono ukugcwala kwezimpawu nezinto ezabiwe zekliniki kuzo zonke lezi zimo, i-comorbidity, kanye nokuphendula ekwelashweni (2).
Ama-subtypes asabalele kakhulu okulutha lokuziphatha kungukungcebeleka ngokugembula (GD), ukuthenga okuphoqayo (i-CB), umlutha wobulili (SA) kanye ne-intanethi yokudlala imidlalo (IGD). Engqulweni yakamuva ye-DSM-5, i-GD ifakiwe esigabeni esisha sokuxilonga esibizwa ngokuthi "Okuhlobene Nezidakamizwa kanye Nezinkinga Zokuphazamiseka," ngenkathi kukhulunywa ngokuthile kokunye okuphathelene nokuziphatha (njenge-CB, SA, ne-IGD) kwaxoxwa ngakho futhi kwafakwa ngaphandle ngenxa yokuntuleka kobufakazi obunamandla.
Ukulutha kokuziphatha kwenzeka kubantu bobabili ubulili, kepha ukwanda kuyahluka ngokuya ngesibalo esingaphansi: amadoda abika amaphesenti aphezulu ku-GD, IGD, naseSA, kuyilapho abesifazane bebika amanani aphezulu e-CB (7). Ngokuphathelene nobudala, lokhu kuphazamiseka kwenzeka kuwo wonke umjikelezo wempilo, kepha izigaba ezimbili zibonakala zinobungozi obuphakeme: ubusha / ukuba mdala nokuguga (8).
Ucwaningo lokuhlola umnikelo weminyaka yokuqalwa kokuphakanyiswa lubonisa ukuthi iziguli ezinokuqala kokuqala zakha iqembu elingaphansi elinamazinga aphezulu wobuntu bomuntu kanye nokuphoqelela, kanti iziguli ezinesikhathi esizayo zakha i-subtype enobungozi obukhulu bokudangala nokukhathazeka, abasebenzisa ukugembula njengengonakalisi kahle indlela yokuguqula imizwa yabo engemihle (9, 10). Ukuqala kokuqala kwe-GD (kuqhathaniswa nokuqala kwesikhathi) nakho kubonakala kuhlobene nokwanda okuphansi kokuphazamiseka kwemizwelo, ukutholakala okuphezulu kokuphazamiseka kobuntu be-cluster B, izikolo eziphakeme embonweni wesici sobuntu ezifuna kanye nezikolo eziphansi ekuziqondiseni (11, 12).
Ngokuphathelene ne-CB, imiphumela yokuqhathaniswa engathembekile futhi engathembekile iye yabikwa, isukela ku-1 kuya ku-20% kuya ngomsuka wamasampula, izincazelo, nezinsimbi zokulinganisa (13-17). Idatha ekhona yesifo se-CB nayo ikhombisile ukuthi iziguli ezifuna ukwelashwa nge-CB zivame ukuhlushwa yizimo eziningi zezifo zengqondo, notshwala be-comorbid kanye / noma ezinye izidakamizwa, ukuphazamiseka kokudla, ukuphazamiseka kwemizwelo, ukukhathazeka, kanye nokunye ukuphazamiseka kokulawula okufakwayo kuvame kakhulu (18). Ukwehluka okuqinile okuncike ebulilini kwe-CB kuchaziwe: ubungozi, ukwanda, kanye namanani wokuqalwa kanye nemvamisa yokusetshenziswa kabi okuphezulu kuphezulu kwabesifazane (1).
Ucwaningo olugxile ku-IGD lukhombisa ukuthi phakathi kwe-3.7 ne-13.0% yabantu abadala abadala bahlangabezana nezindlela zokusebenzisa i-inthanethi eziyinkinga (19, 20), nokuthi i-IGD ivame kakhulu kumasampula amasha (21). Ukuhlangana kwe-IGD kufaka amazinga aphezulu wokuzibeka ebungozini kanye nokuphoqelela, ukunciphisa ukubambezeleka okuphezulu, ukuzwela okuphezulu kokwenqatshwa komphakathi kanye namazinga aphezulu ekulweni kokuphikiswa, ukugwema ukulimala nokungqubuzana phakathi kwabantu (22-24).
Ekugcineni, ucwaningo nge-SA luphetha ngokuthi ukwanda kwesibalo sabesilisa kuphezulu ngokusobala uma kuqhathaniswa nabesifazane (25-28). Amazinga aphezulu ezenhlalo yezomnotho, amaphuzu aphezulu ebuntwini afuna ukubuzwa kanye nezikolo eziphansi ekugwemeni ukulimala kuyizinto eziyingozi e-SA (29, 30). Olunye ucwaningo lwe-etiological luveze ukuthi i-SA ihlobene nezici zobuntu obuhlangene, ukungabi naluvalo, ukuqinisekiswa kwabantu, ukuzithemba, kanye nezinga eliphakeme lokuxoshwa (31).
Iqiniso lokuthi njengamanje yi-GD kuphela efakiwe kwi-DSM-5 itholakala ngokuntuleka kokuvumelana mayelana nokubheka imilutha yokuziphatha njengokuphazamiseka kwengqondo (32). Ngokwengxenye lokhu kungachaza ukwanda kokuphazamiseka kwalesi sifo ngokuhambisana nokunye ukuluthwa kokuziphatha. Kuyinselelo futhi ukuthola ukubhebhetheka kwezimo ezingemukelwa njengezinkinga futhi ungachithi amathuluzi wokuhlonza abekiwe (33). Ukuba nezindlela zokuxilonga zalokhu kumlutha kuzovumela ulwazi oluningi lwe-etiology, ukuvimbela kanye nokwelashwa kwezinye izidakamizwa zokuziphatha (34). Ngokunjalo, ukufakwa kwezinye izidakamizwa zokuziphatha kungaba nomthelela kwizinsizakalo zezempilo futhi kungasiza ekunciphiseni ukwenqena kweziguli ukuthola ukwelashwa (34).
Izinhloso
Ngokwazi kwethu konke, isibalo esilinganiselwe sezifundo silinganise umnikelo othize wezocansi, ukuqala kanye nobude bokuziphatha okuluthayo kumasampula athintekayo emtholampilo kufaka phakathi ama-subtypes wokuziphatha umlutha ohlukile. Ngakho-ke, inhloso yalolu cwaningo bekuwukuhlola isisindo esithile salezi zinto eziguqukayo esimweni somtholampilo sokwelashwa ezifuna iziguli ezitholakala zinomkhuhlane we-GD, IGD, CB, kanye ne-SA.
izindlela
Abahlanganyeli
Isampula ifakiwe n = 3,366 iziguli ezilandelanayo ezifuna ukwelashwa eziye kuyunithi yesibhedlela ezikhethekile eziluthwe nokuziphatha e-Barcelona, Spain Ukuqashwa kabusha kwenzeke phakathi kukaJanuwari-2005 neSetember-2016. Izindlela zokufaka zazihlanganisa izindlela zokuhlangana zokuxilongwa kwe-GD, IGD, i-CB, noma i-SA njengesizathu esiyisisekelo sokubonisana nokuba ngaphezulu kweminyaka engu-18. Izindlela zokuxoshwa zazinokukhubazeka ngokomqondo noma ukuphazamiseka kwengqondo okunzima (njenge-schizophrenia noma ezinye izifo zengqondo noma i-bipolar disorder).
Isibalo sabahlanganyeli esikhishwe ngenxa yobukhona be-comorbid bokuluthwa okuhlukile bokuziphatha babephansi (n = 5, isiguli se-1 esibike nge-GD + CB, i-1 eyethula i-GD + SA, i-2 nge-CB + SA, kanye ne-1 nge-SA + IGD). Ngakolunye uhlangothi, njengoba amasampula amancane we-IGD ne-SA efaka abesifazane abambalwa kakhulu (n ≤ 2), ababambiqhaza besifazane abakhiswanga kulawa maqembu womabili ukugwema ukubandlulula okungaba khona emiphumeleni ngenxa yokuvama okuphezulu kakhulu kwabesifazane kulezi zindlela ezingezansi.
Izindlela
Imininingwane yemibuzo yokuhlonza ukugembula kwe-pathological ngokusho kwe-DSM Criteria (35)
Le mibuzo yemibuzo ye-19-ivumela ukuhlolwa kwe-DSM-5 (32) izindlela zokuxilonga ze-GD. Ukuqina kokuguqula nezikolo zokugembula zangaphandle kwinguqulo yangempela bekukuhle kakhulu (r = 0.77 yamasampula abamele kanye ne-r = 0.75 yamaqembu okwelapha ukugembula; (35). Ukuvumelana okungaphakathi ekuvumelaniseni kweSpain okusetshenziswe kulolu cwaningo kwakuyi-α = 0.81 yesibalo sabantu jikelele kanye ne-α = 0.77 yamasampula wokulashwa kokugembula (36). Kulolu cwaningo, inani lokuhlaziywa kwenqubo ye-DSM-5 ye-GD yahlaziywa, futhi ukungaguquguquki kwangaphakathi kwakuyi-α = 0.804 kusampula.
Izinqubo zokuxilonga zokuthenga okuphoqelekile (37)
Lezi zinqubo, esezamukelwe kabanzi emphakathini ocwaningayo, zazisetshenziselwa ukuqinisekisa ubukhona be-CB kusampula. Uhlu lwemibuzo luhlola "ukuthenga izimilo, imizwa ehlobene, imicabango engaphansi, kanye nezinga lezinto zokuthenga nokuthenga" (38).
Izinqubo zokuxilonga ze-IGD ngokuya ngeGriffiths neHunt (39, 40)
Ukuhlola ukuxilongwa kwe-IGD kanye nokusungula izinga lokuncika kulokho kuphazamiseka, ochwepheshe bezemitholampilo benze ingxoxo yobuso nobuso bebheka isikali esakhiwe nguGriffiths noHunt (39, 40). Lokhu kuxoxwa kuhlolwe izici ezinjengemvamisa yokuziphatha okuyinkinga, ukuphazamiseka okukhiqizwa ekusebenzeni nsuku zonke ngenxa yokusetshenziswa kabi kwemidlalo ye-intanethi, ukuba khona kokubekezelelana nobunzima ekuphathweni kwezingcingo, kanye nenombolo yezindlela ze-DSM-5 [ngokuya ngeSigaba I-III, (32)].
Izindlela zokuhlonza umlutha wobulili ngokuya nge-DSM-IV-TR (32)
Ukuhlola i-SA, ibhethri lezinto lalungiswa, elalususelwa encazelweni ehlongozwayo kwi-DSM-IV-TR (41) esigabeni sokungahambi kahle ngokocansi okungekho ngenye indlela ecacisiwe (302.9). Ekwenzeni uhlolo lwethu, le ncazelo yomtholampilo elandelayo yanikezwa isisindo esikhethekile: "usizi ngesimo sobudlelwano bezocansi obuphindaphindwayo obubandakanya ukulandelana kwabathandi ababonwa ngumuntu uqobo njengezinto ezizosetshenziswa."
I-Temperament kanye ne-yokusungula uhlolo-olubukeziwe (TCI-R) (42)
Lesi sihloko esithembekile futhi esisemthethweni semibuzo ye-240-nto ekala ubuntu obungu-7: ubuntu obukhona (ubuhlakani bokufuna, ukugwema ukulimala, ukuxhomekeka komvuzo nokuphikelela) nobukhulu bezinhlamvu ezintathu (ukuziqondisa, ukubambisana, nokuzimela). Zonke izinto zilinganiswa esikalini sohlobo lwe-5-point Likert-Type. Kusetshenziswe inguqulo ye-Spanish evumelekile (43). Isikali enguqulweni ebukeziwe yaseSpain sikhombise ukungaguquguquki kwangaphakathi okwanele (inani le-alpha α elisho uCronbach elingu-0.87). Ocwaningweni, izinkomba zokuguquguquka zisuselwa kokuhle (α = 0.70 yentsha efuna iscale) kuya kokuhle kakhulu (α = 0.859 yokuphikelela subscale).
Uhlu lokuhlola izimpawu lubukeziwe (44)
Leli phepha lemibuzo lihlaziya uhla olubanzi lwezinkinga zengqondo nezimpawu ze-psychopathological. Leli phepha lemibuzo liqukethe izinto ze-90 futhi lilinganisa ubukhulu bezimpawu eziyisishiyagalolunye eziyisisekelo: ukuzikhethela okuthile, ukuphoqelelwa, ukuzwela komuntu, ukudangala, ukukhathazeka, ubutha, ukukhathazeka nge-phobic, umbono we-paranoid, kanye ne-psychoticism. Kubandakanya nama-indices amathathu womhlaba wonke ahlanganisiwe: (1) inkomba yokudonsa komhlaba (GSI), eklanyelwe ukukala usizi lwengqondo jikelele; (2) inkomba yokucindezeleka kwesibonakaliso (i-PSDI), ukukala ubukhulu bezimpawu; futhi (3) inani eliphelele lesimpawu (PST), elibonisa izimpawu zokuzibika. Kusetshenziswe inguqulo ye-Spanish evumelekile (45). Isikali sokuqinisekisa saseSpain sithole izinkomba ezinhle ze-psychometrical, ngokuvumelana kwangaphakathi okushoyo kwe-0.75 (i-alpha yeCronbach). Lolu cwaningo luhlaziya amaphuzu omhlaba we-GSI njengesilinganiso sesimo se-psychopathological global (ukungaguquguquki kwesampula lethu kuhle kakhulu kulesi sikali, α = 0.981).
Okunye okuguquguqukayo komphakathi kanye nokwelashwa
Ukungezelelwa okwengeziwe kwabantu, imitholampilo, kanye nokuhlalisana komndeni / komndeni kwakalwa kusetshenziswa ukuhlolisiswa okwenziwe ngobuso ngobuso emtholampilo okuchazwe kwenye indawo (46). Ukuguquguquka okuhlanganisiwe kufaka phakathi unyaka wokuqala kokuphazamiseka, izikweletu eziqoqiwe ngenxa yokulutha kanye nesimo senhlalo esilinganiswa ngenkomba yeHollingshead (inhlolovo eyenzelwe ukukala isimo senhlalo yabantu ngokususelwe ekutholekeni kwezemfundo nodumo lomsebenzi; (47).
Inqubo
Ochwepheshe bezengqondo abanolwazi nezengqondo, abaneminyaka engaphezu kwe-15 yokuhlangenwe nakho komtholampilo emkhakheni wokuphazamiseka kwemilutha, benza izingxoxo ezimbili zobuso ngobuso ukuze baqoqe imininingwane ephathelene nomtholampilo futhi bacacise ngokuxilongwa kwezifo zesiguli ngasinye. Zonke izindlela ezihlaziywe kulolu cwaningo zihambisana nokuhlolwa kwesisekelo, okwedlule ekuqaleni kokwelashwa.
Ukuhlaziywa kwesitatimende
Ukuhlaziywa kwesitatimende kwenziwa ngeStata 15 yeWindows. Ama-coefficients wokuhlanganisa kaPearson alinganise ubudlelwane phakathi kweminyaka yobudala kanye nesikhathi sokuziphatha okuluthayo okunenkinga nobuntu kanye nephrofayili yomtholampilo. Umnikelo othize wobulili beziguli, ukuqala, nobude benkinga ebucayi bokuthi umlutha kanye nesimo se-psychopathological kukalwe ngokuhlehliswa okungalungile kwe-binomial kanye ne-regression multiple regression (ukuthola izikweletu ezihlanganisiwe kanye nesikolo se-SCL-90-R GSI). Lezi zinhlobo zifake futhi zahlola ukuhlangana kocansi-ekuqaleni nokuya ocansini isikhathi: (a) ngamapharamitha wokuxhumana afanele, imiphumela eyodwa yobudala babahlanganyeli ilinganiselwa emaqenjini amathathu achazwe ama-quartiles 1 no-3 weminyaka yobudala ukuqala [ekuqaleni (ukuqala ngaphambi kweminyaka engama-20), okuphakathi (ukuqala phakathi kweminyaka engama-20 nengama-35) nokuphuza (ukuqala ngemuva kweminyaka engama-35)]; futhi (b) ngamapharamitha wokuxhumana angahambelani, imiphumela emibi ilinganisiwe yahunyushwa. Amamodeli azimele atholakele i-subtype ngayinye yokuxilonga (i-GD, i-CB, i-IGD, ne-SA). Umnikelo wezocansi awuzange uhlolwe i-IGD ne-SA, ngoba abekho abesifazane abafakiwe kulezi zingqimba ngenxa yemvamisa yabo ephansi emaqenjini.
Ethics
Lolu cwaningo lwenziwe ngokuhambisana nohlobo lwakamuva lweSimemezelo saseHelsinki. Ikomidi Lezimilo laseBellvitge University Hospital (Barcelona, Spain) ligunyaze lolu cwaningo, futhi imvume esayiniwe yatholakala kubo bonke ababambe iqhaza ekugcineni.
Imiphumela
Izici zesampula
Ingxenye engenhla yeTafula AIthebula11 ifaka nencazelo yokuhlukahluka kocwaningo lwe-socialodemographic. Iqonde iminyaka yokulandelana yesampula ephelele yayineminyaka engu-42.5 (SD = 13.5, enobubanzi obuphakathi kweminyaka engu-18 ne-75 yeminyaka), isho ubudala bokuqalisa komlutha wokuziphatha yayineminyaka engu-29.9 (SD = 11.5) nencazelo Isikhathi sokuphazamiseka kwaba yiminyaka eyi-6.2 (SD = 5.9).
Ithebula 1
Ukuchazwa kwesampula: Ukuhlukahluka komphakathi kanye nokwelashwa.
| GD; n = 3,174 | IGD; n = 45 | I-CB; n = 113 | SA; n = 34 | |||||||
|---|---|---|---|---|---|---|---|---|---|---|
| n | % | n | % | n | % | n | % | χ2 | p | |
| GENDER | ||||||||||
| Abesifazane | 283 | 8.9 | 0 | 0 | 85 | 75.2 | 0 | 0 | 502.6 | |
| Abesilisa | 2891 | 91.1 | 45 | 100 | 28 | 24.8 | 34 | 100 | ||
| ORIGIN | ||||||||||
| Spain | 2934 | 92.4 | 39 | 86.7 | 111 | 98.2 | 33 | 97.1 | 8.65 | 0.034 |
| Ohlala kwamanye amazwe | 240 | 7.6 | 6 | 13.3 | 2 | 1.8 | 1 | 2.9 | ||
| IMFUNDO | ||||||||||
| Okuyinhloko | 1905 | 60.0 | 24 | 53.3 | 43 | 38.1 | 9 | 26.5 | 85.40 | |
| Secondary | 1092 | 34.4 | 20 | 44.4 | 46 | 40.7 | 16 | 47.1 | ||
| University | 177 | 5.6 | 1 | 2.2 | 24 | 21.2 | 9 | 26.5 | ||
| CIVIL STATUS | ||||||||||
| Single | 1212 | 38.2 | 41 | 91.1 | 43 | 38.1 | 9 | 26.5 | 57.43 | |
| Oshadile - umlingani | 1534 | 48.3 | 3 | 6.7 | 51 | 45.1 | 17 | 50.0 | ||
| Ohlukanisile - uhlukanisiwe | 428 | 13.5 | 1 | 2.2 | 19 | 16.8 | 8 | 23.5 | ||
| INDEX YOKUXHUMANA | ||||||||||
| High | 46 | 1.4 | 1 | 2.2 | 4 | 3.5 | 2 | 5.9 | 53.27 | |
| Okuphakathi nendawo | 138 | 4.3 | 0 | 0.0 | 18 | 15.9 | 4 | 11.8 | ||
| Medium | 339 | 10.7 | 6 | 13.3 | 14 | 12.4 | 4 | 11.8 | ||
| Okuphakathi nendawo | 967 | 30.5 | 12 | 26.7 | 32 | 28.3 | 14 | 41.2 | ||
| ongaphakeme | 1684 | 53.1 | 26 | 57.8 | 45 | 39.8 | 10 | 29.4 | ||
| UMSEBENZI | ||||||||||
| Ayisebenzi | 1414 | 44.5 | 36 | 80.0 | 53 | 46.9 | 15 | 44.1 | 22.69 | |
| Iqashwe | 1760 | 55.5 | 9 | 20.0 | 60 | 53.1 | 19 | 55.9 | ||
| aIZIVUMELWANO ZOKULULA | ||||||||||
| Cha | 374 | 11.8 | 2 | 4.4 | 13 | 11.5 | 2 | 5.9 | 3.43 | 0.330 |
| Yebo | 2800 | 88.2 | 43 | 95.6 | 100 | 88.5 | 32 | 94.1 | ||
| Ngisho | SD | Ngisho | SD | Ngisho | SD | Ngisho | SD | F | P | |
| Kudala, ONSET NOKUHLAZIYA | ||||||||||
| Ubudala (iminyaka yobudala) | 42.8 | 13.5 | 22.6 | 8.4 | 42.6 | 11.5 | 42.6 | 11.9 | 33.76 | |
| Ukuphazamiseka kwesethi (iminyaka yobudala) | 29.9 | 11.5 | 19.3 | 8.1 | 32.9 | 12.0 | 33.7 | 13.0 | 16.82 | |
| Ukuphazamiseka kwesikhathi (iminyaka) | 6.2 | 6.0 | 3.3 | 2.5 | 6.8 | 5.8 | 6.0 | 5.7 | 3.90 | 0.009 |
| I-PSYCHOLOGY: SCL-90R | ||||||||||
| Isikolo se-GSI | 1.05 | 0.72 | 0.86 | 0.76 | 1.58 | 0.91 | 1.25 | 0.78 | 20.21 | |
| UKUHAMBELA KWABASEBENZI: TCI-R | ||||||||||
| Ukufuna inoveli | 108.9 | 14.3 | 103.7 | 13.1 | 114.9 | 14.4 | 110.8 | 14.3 | 7.85 | |
| Ukugwema okulimazayo | 101.1 | 17.0 | 102.6 | 22.8 | 111.0 | 19.7 | 102.1 | 17.5 | 10.80 | |
| Ukuthembela kumvuzo | 98.5 | 14.8 | 92.3 | 17.1 | 103.2 | 17.0 | 100.5 | 15.2 | 5.84 | 0.001 |
| ukuphikelela | 108.5 | 20.1 | 93.6 | 20.8 | 106.8 | 18.8 | 103.6 | 21.1 | 8.20 | |
| Ukuziqondisa | 127.0 | 21.1 | 127.1 | 25.7 | 124.1 | 23.9 | 116.9 | 19.6 | 2.91 | 0.033 |
| Ukubambisana | 130.4 | 16.3 | 126.8 | 18.5 | 133.9 | 15.7 | 127.4 | 15.1 | 2.57 | 0.053 |
| Ukuzikhandla | 64.0 | 15.3 | 57.2 | 14.1 | 65.4 | 16.5 | 63.1 | 14.0 | 2.97 | 0.031 |
Note.
I-GD: ukuphazamiseka kokugembula. IGD: ukuphazamiseka kwemidlalo ye-inthanethi. I-CB: ukuthenga okuphoqayo. SA: umlutha wobulili.
SD: ukuphambuka okujwayelekile. - Le ndlela ayitholakalanga kuleli qembu.
Ingxenye engezansi yeTafula AIthebula11 ikhombisa ukwabiwa kokuguquguquka kwemitholampilo nokuqhathanisa phakathi kwama-subtypes wokuxilonga. Iqembu le-IGD lifaka ababambiqhaza abancane kunabo bonke, abaneminyaka yobudala ephansi kakhulu ekuqaleni kokuphazamiseka kobunzima kanye nesikhathi sokuphazamiseka kwengqondo. Mayelana nezimpawu zobuntu, i-CB ivume njengamazinga aphezulu kakhulu ekufuneni izinto ezintsha, ukugwema ukulimala, ukuncika komvuzo nokuziguqula, kulandele i-GD.
Ukuhlangana phakathi kweminyaka yokuqalwa nesikhathi sokuthathwa kwezinyathelo zokwelashwa nobuntu
Ithebula AIthebula22 ifaka matrix yokuhlobanisa ukuhlola ubudlelwane phakathi kweminyaka yokuqalwa (iminyaka yobudala) nobude (iminyaka) yokuluthwa kokuziphatha ngakunye nezinyathelo zomtholampilo. Eqenjini le-GD, kuqhamuke izinhlangano ezimbili: kusampula wesilisa, ukuqala kokuqala kwaxhunyaniswa nenombolo ephezulu yezindlela ze-DSM-5, kuthi ngokwesampula yabesifazane, ukuqala kokuqala kwaxhunyaniswa nezinga eliphakeme lokufuna izikolo.
Ithebula 2
Ukuhlangana phakathi kweminyaka yokuqalwa nobude be-BA ngemikhakha yobuntu nobuntu.
| GD | I-IGD | CB | SA | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Abesifazane n = 283 | Men n = 2,891 | Men n = 45 | Abesifazane n = 85 | Men n = 28 | Men n = 34 | |||||||
| Qala | I-Durat. | Qala | I-Durat. | Qala | I-Durat. | Qala | I-Durat. | Qala | I-Durat. | Qala | I-Durat. | |
| I-DSM-5 ingqikithi yenqubo | -0.24 | 0.10 | -0.19 | 0.05 | 0.44 | -0.05 | - | - | - | - | - | - |
| Qoqa izikweletu | -0.14 | 0.00 | -0.01 | 0.04 | - | - | -0.15 | 0.25 | 0.03 | 0.18 | -0.59 | 0.50 |
| I-PSYCHOLOGY: SCL-90R | ||||||||||||
| Isikolo se-GSI | -0.11 | 0.04 | -0.04 | 0.10 | 0.25 | 0.11 | -0.03 | 0.06 | 0.36 | -0.11 | -0.18 | 0.07 |
| UKUHAMBELA KWABASEBENZI: TCI-R | ||||||||||||
| Ukufuna inoveli | -0.18 | 0.15 | -0.25 | 0.02 | 0.01 | -0.05 | -0.19 | -0.04 | -0.05 | 0.23 | 0.16 | -0.14 |
| Ukugwema okulimazayo | -0.15 | -0.06 | 0.07 | 0.07 | 0.26 | 0.08 | -0.12 | -0.12 | 0.34 | -0.21 | -0.08 | 0.07 |
| Ukuthembela kumvuzo | 0.02 | 0.06 | 0.04 | -0.07 | -0.10 | -0.11 | -0.27 | 0.07 | -0.07 | 0.17 | 0.17 | -0.06 |
| ukuphikelela | -0.02 | -0.06 | -0.03 | -0.07 | -0.10 | 0.02 | 0.02 | 0.12 | -0.01 | 0.27 | -0.18 | 0.09 |
| Ukuziqondisa | 0.06 | -0.04 | 0.06 | -0.09 | -0.23 | -0.15 | 0.07 | 0.09 | -0.25 | 0.25 | -0.03 | 0.14 |
| Ukubambisana | 0.01 | 0.00 | 0.09 | -0.07 | -0.13 | -0.06 | -0.05 | 0.13 | -0.28 | 0.01 | 0.02 | 0.24 |
| Ukuzikhandla | 0.19 | -0.03 | 0.16 | 0.05 | 0.35 | 0.22 | 0.29 | 0.08 | 0.19 | 0.31 | 0.01 | 0.08 |
Qaphela. I-GD, ukuphazamiseka kokugembula; IGD, ukuphazamiseka kwemidlalo ye-inthanethi; I-CB, ukuthenga okuphoqayo; SA, umlutha wobulili.
Qaphela. Okugqamile: ukuhlangana kokumaphakathi (| r |> 0.24) kububanzi obuhle (| r |> 0.37). - Ayitholakali kuleli qembu.
Kwabesifazane abatholakala be-CB, iminyaka yobudala yokuthomba yayihlobene namazinga aphezulu wokuxhomekeka kumvuzo kanye namazinga aphansi wokuzithoba, futhi isikhathi eside sale nkinga sasihambisana nezikweletu eziphakeme kakhulu. Okwabesilisa kule nkinga yokuxilonga (i-CB): (a) iminyaka yokuqala yokuqalisa yayixhunyaniswa nezikolo eziphansi ze-SCL-90R kanye namazinga wokugwema ukulimala, nokuzibusa okuphezulu kanye nezikolo zokubambisana; (b) ubude besikhathi sokuphazamiseka okuhambisana namazinga aphezulu ezimweni zobuntu zokuphikelela, ukuziqondisa nokuzibona.
Kwabesilisa abahlangabezane nenkambiso ye-SA, isikhathi esiphakeme sasihlobene nezikolo eziphakeme zokuzonda.
Umthelela wobulili, iminyaka yokuqalwa, kanye nesikhathi sokuphazamisa ubucayi
Ithebula AIthebula33 iqukethe amamodeli ahlukahlukene wokucabanga abona umnikelo othize wezocansi, ubudala kanye nobude besikhathi sokuphazamiseka ezenzweni zokulutha kobulelesi. Kutholwe amamodeli ahlukile ngokuphazamiseka ngakunye (i-GD, i-CB, i-IGD, ne-SA) ngesilinganiso ngasinye sokuqina (inani lezinto ze-DSM-5, ama-cumates debs, kanye nesikolo se-SCL-90R GSI). Isibonelo, i-Model-1 ihlola ukunikela kokuhlukahluka okuzimele kocwaningo (ubulili, ubudala nobude) kwinombolo yokuxhomekeka ethembekile yemibandela ye-DSM-5 ngokuqondile isampula ye-GD. Ngokubuyisa ngakunye ama-B-parameter angajwayelekile, iphutha elijwayelekile (SE), i-95% isikhawu sokuzithemba (i-95% CI ye-B), izibalo zokuqhathanisa (i-Wald-chisquare yokubuyisa okungalungile kwe-binomial kanye ne-T ngokuhlehla okuqondile) kanye p-bikwa.
Ithebula 3
Umthelela wobulili, ukuqala kanye nesikhathi kuma-subtypes e-BA ahlukile.
| B | SE | I-95% CI (B) | cIsitatimende | p | ||
|---|---|---|---|---|---|---|
| ISIMEMO SE-GAMBLING; n = 3,174 | ||||||
| [Model-1] aIsikhombisi: Imibandela ye-DSM-5 | ||||||
| (Qondisa) | 2.126 | 0.095 | 1.94 | 2.31 | 505.20 | 0.001 |
| Ucansi (0: abesifazane; 1: owesilisa) | -0.075 | 0.070 | -0.21 | 0.06 | 1.16 | 0.282 |
| Isikhathi (iminyaka) | 0.002 | 0.003 | 0.00 | 0.01 | 0.44 | 0.508 |
| Iminyaka yokuqalisa (iminyaka yobudala) | -0.005 | 0.002 | -0.01 | 0.00 | 9.18 | 0.002 |
| [Model-2] aUkubhala: Qongelela izikweletu | ||||||
| (Qondisa) | 10.068 | 0.256 | 9.57 | 10.57 | 1543.67 | 0.001 |
| Isikhathi (iminyaka) | 0.012 | 0.004 | 0.01 | 0.02 | 10.58 | 0.001 |
| dUcansi (ekuqaleni kokuqala) | 0.579 | 0.304 | -0.02 | 1.18 | 3.63 | 0.057 |
| dUkuya ocansini (kokuqala okuphakathi) | 0.323 | 0.106 | 0.12 | 0.53 | 9.29 | 0.002 |
| dUcansi (ukuqala sekwedlule isikhathi) | 0.950 | 0.108 | 0.74 | 1.16 | 77.35 | |
| Iminyaka yokuqalisa (kuba abesifazane) | -0.027 | 0.007 | -0.04 | -0.01 | 16.28 | |
| Iminyaka yokuqalisa (ibe ngamadoda) | 0.023 | 0.002 | 0.02 | 0.03 | 106.92 | |
| Ukuxhumana: Ucansi ngokuqala | 0.050 | 0.007 | 0.04 | 0.06 | 50.62 | 0.001 |
| [Model-3] bIndawo yokuhlala: SCL-90R GSI | ||||||
| (Qondisa) | 1.703 | 0.158 | 1.39 | 2.01 | 10.74 | 0.001 |
| Isikhathi (iminyaka) | 0.011 | 0.002 | 0.01 | 0.02 | 5.08 | |
| dUcansi (ekuqaleni kokuqala) | -0.433 | 0.163 | -0.75 | -0.11 | -2.65 | 0.008 |
| dUkuya ocansini (kokuqala okuphakathi) | -0.634 | 0.074 | -0.78 | -0.49 | -8.63 | |
| dUcansi (ukuqala sekwedlule isikhathi) | -0.422 | 0.073 | -0.57 | -0.28 | -5.76 | |
| Iminyaka yokuqalisa (kuba abesifazane) | -0.007 | 0.004 | -0.02 | 0.00 | -1.76 | 0.048 |
| Iminyaka yokuqalisa (ibe ngamadoda) | -0.002 | 0.001 | 0.00 | 0.00 | -1.46 | 0.143 |
| Ukuxhumana: Ucansi ngokuqala | 0.005 | 0.004 | 0.00 | 0.01 | -1.82 | 0.068 |
| UKWAKHIWA KULULA; n = 113 | ||||||
| [Model-4] aUkubhala: Qongelela izikweletu | ||||||
| (Qondisa) | 11.149 | 0.437 | 10.29 | 12.00 | 652.20 | 0.001 |
| Ucansi (0: abesifazane; 1: owesilisa) | -0.497 | 0.246 | -0.98 | -0.01 | 4.07 | 0.044 |
| Isikhathi (iminyaka) | 0.064 | 0.019 | 0.03 | 0.10 | 11.39 | 0.001 |
| Iminyaka yokuqalisa (iminyaka yobudala) | -0.022 | 0.012 | -0.05 | -0.00 | 3.64 | 0.050 |
| [Model-5] bIndawo yokuhlala: SCL-90R GSI | ||||||
| (Qondisa) | 1.861 | 0.342 | 1.18 | 2.54 | 5.44 | 0.001 |
| Isikhathi (iminyaka) | -0.010 | 0.016 | -0.04 | 0.02 | -0.66 | 0.508 |
| dUcansi (ekuqaleni kokuqala) | -0.430 | 0.572 | -1.56 | 0.70 | -0.75 | 0.453 |
| dUkuya ocansini (kokuqala okuphakathi) | -0.735 | 0.284 | -1.30 | -0.17 | -2.59 | 0.011 |
| dUcansi (ukuqala sekwedlule isikhathi) | 0.043 | 0.318 | -0.59 | 0.67 | 0.13 | 0.893 |
| Iminyaka yokuqalisa (kuba abesifazane) | -0.003 | 0.009 | -0.02 | 0.01 | -0.36 | 0.719 |
| Iminyaka yokuqalisa (ibe ngamadoda) | 0.024 | 0.015 | -0.01 | 0.05 | 1.61 | 0.112 |
| Ukuxhumana: Ucansi ngokuqala | -0.733 | 0.406 | -1.54 | 0.07 | -1.81 | 0.074 |
| ISIQINISO SE-INTERNET GAMBLING; n = I-45 (KUPHELA AMADODA) | ||||||
| [Model-6] aIsikhombisi: Imibandela ye-DSM-5 | ||||||
| (Qondisa) | 0.752 | 0.540 | -0.31 | 1.81 | 1.94 | 0.164 |
| Isikhathi (iminyaka) | 0.005 | 0.072 | -0.14 | 0.15 | 0.01 | 0.940 |
| Iminyaka yokuqalisa (iminyaka yobudala) | 0.020 | 0.021 | -0.02 | 0.06 | 0.93 | 0.335 |
| [Model-7] bIndawo yokuhlala: SCL-90R GSI | ||||||
| (Qondisa) | 0.231 | 0.372 | -0.52 | 0.983 | 0.62 | 0.539 |
| Isikhathi (iminyaka) | 0.051 | 0.049 | -0.05 | 0.150 | 1.05 | 0.298 |
| Iminyaka yokuqalisa (iminyaka yobudala) | 0.023 | 0.014 | -0.01 | 0.052 | 1.63 | 0.110 |
| ISEXWAYISO SEX; n = I-34 (KUPHELA AMADODA) | ||||||
| [Model-8] aUkubhala: Qongelela izikweletu | ||||||
| (Qondisa) | 14.942 | 1.237 | 12.52 | 17.37 | 145.88 | 0.001 |
| Isikhathi (iminyaka) | 0.151 | 0.193 | -0.23 | 0.53 | 0.62 | 0.432 |
| Iminyaka yokuqalisa (iminyaka yobudala) | -0.259 | 0.045 | -0.35 | -0.17 | 32.84 | |
| [Model-9] bIndawo yokuhlala: SCL-90R GSI | ||||||
| (Qondisa) | 1.651 | 0.449 | 0.74 | 2.57 | 3.68 | 0.001 |
| Isikhathi (iminyaka) | -0.005 | 0.025 | -0.06 | 0.05 | -0.18 | 0.856 |
| Iminyaka yokuqalisa (iminyaka yobudala) | -0.011 | 0.011 | -0.03 | 0.01 | -1.01 | 0.321 |
Eqenjini le-GD, inani eliphakeme lezindlela ze-DSM-5 zazihlotshaniswa nobudala bokuqala (B = −0.005; p = 0.002), ngenkathi kungatholakali umnikelo wezibalo ocansini lweziguli noma isikhathi sesifo, futhi akukho ukuxhumana phakathi kocansi nokuqala nobude besikhathi obutholakele le nqubo (Model-1 kuThebula AI-Table3).3). Kule subtype ye-BA, lapho kubhekwa umbandela wesikweletu we-cumrate (Model-2 kuThebula AI-Table3)3) lesi silinganiso sandiswa kwiziguli ezinde, futhi ukuxhumana ngezocansi ngeminyaka yokuqalwa kwagcinwa futhi kufanelekile: (a) imiphumela eyodwa yocansi ikhombisile ukuthi amadoda ayevame ukuqongelela izikweletu eziningi, futhi lo mehluko ukhuphuka ngeminyaka yobudala ; futhi (b) imiphumela eyodwa yobudala bokuqalwa ibonise ukuthi, kwabesifazane, ekuqaleni kokuqala, benyuka kakhulu izikweletu ezihlanganisiwe ngenkathi zenzelwe abesilisa, lapho bekhulile ukuqala kokuqala, kuphakama izikweletu.
Okwebalulwa kwe-SCL-90-R GSI (Model-3 kuThebula AI-Table3),3), isimo esibi kakhulu se-psychopathological sasihlobene nesikhathi esiphakeme sokuphazamiseka, futhi ukuhlangana kwezocansi ngokuqala kwakubalulekile futhi ukuchaza lo mphumela: (a) imiphumela eyodwa yocansi kufakazelwa ukuthi abesifazane babehlala bebhalisa amazinga aphezulu we-psychopathological uma kuqhathaniswa nabesilisa, kepha umphumela wesayizi umehluko uncike eminyakeni yobudala bokuqala kokuphazamiseka (umphumela ophakeme ubhaliselwe ukuqala phakathi kwe-20 ne-35); futhi (b) isikhathi sokuqala kokuqala kwale nkinga besiyisibalo nje sesimo esibi kakhulu sezengqondo kubantu besifazane, ngenkathi ukuqala kwalesi sifo bekungafanelekile ekuchazeni amazinga e-GSI emadodeni.
Eqenjini le-CB, qongelela izikweletu ngenxa yokuthenga (i-Model-4 kuThebula AI-Table3)3) kwandiswe kwabesifazane abanesikhathi eside kanye nobudala bokuqala. Akukho ukusebenzisana phakathi kocansi nobudala kanye nobude besikhathi esivelile. Imodeli elungiswe ngokwezinga le-psychopathological global ku-CB (Model-5 kuThebula AI-Table3)3) wagcina ukuhlangana kokuya ocansini ekuqaleni, futhi imiphumela yalokhu kulawulwa yakhombisa ukuthi isimo sobuchopho esibi sibhaliselwe abesifazane uma siqhathaniswa nabesilisa, kodwa kuphela ezigulini ezibike ubudala obuphakathi kokuqala kwale nkinga (phakathi kwe-20 ne-35 ubudala).
Kwabangaphansi kwe-IGD neSA, ubulili abuzange bufakwe kumamodeli ngoba abekho abesifazane ababefakiwe kulawa maqembu. Okwe-IGD, akukho mnikelo wezibalo wesikhathi nokuqalwa okuqhamuka ukuchaza inani le-DSM-5 criteria (Model-6 kuThebula AI-Table3)3) kanye namazinga we-psychopathological global (Model-7) kuThebula AI-Table3).3). Kwabesilisa abaseqenjini laseSA, izikweletu ezenzelwe ukukhokha imali zinyuke kakhulu kwiziguli ezineminyaka yobudala obusha (Model-8 kuThebula AI-Table3),3), ngenkathi ubude besikhathi nokuqala kwakungeyona ingxenye yomthelela ngokwengqondo (i-Model-9 kuThebula AIthebula33).
Ingxoxo neziphetho
Lolu cwaningo luhlole ubudlelwane phakathi kocansi lwesiguli, ubudala bokuqala kanye nesikhathi sokuluthwa kokuziphatha emgomweni we-phenotype (kufaka nobunzima benkinga, isimo se-psychopathological kanye nezimpawu zobuntu). Ukwehlukahlukana phakathi kwe-GD, IGD, i-CB, ne-SA kwavivinywa, ngenhloso yokuthi kukhanye iqhaza endimeni yokulawula umlutha wokuziphatha.
Inhlangano yezocansi, ukuqala nobude nobunzima, kanye nesimo sokusebenza kwengqondo
Imiphumela yethu ikhombisa ukuthi, sekukonke, iphethini ethile yobudlelwano yayihlukile ngokuya ngokuxilongwa kokulutha kokuziphatha. Sekukonke, umsebenzi wethu uhlinzeka ngobufakazi obusha obumayelana nengxenye yobuningi bemilutha yokuziphatha, lapho umnikelo wezinto eziguqukayo njengobudala bokuqala, ubude besifo noma izici zobuntu zidlala indima eyehlukile kuye ngohlobo lokuxilonga kanye neziguli ' ucansi. Izifundo zangaphambilini zase zithole imiphumela efanayo maqondana nokwehluka ngakunye ekuluthweni kokuziphatha, kuqashelwa ukuthi kufanele kucatshangwe njengeqoqo lezimo zomtholampilo (1, 48).
Ama-correlates athile eminyaka yokuqala nawo abukeka ancike ku-subtype yokuxilonga kanye nocansi lweziguli. Lokhu kuxhumana okungahle kwenzeke kuphawuleka kakhulu kwi-GD ne-CB: a) ku-GD, ukuqala kokuqala kuhambisana nobunzima obukhulu kwabesilisa naku-b) ku-CB, ukuqala kwangaphambilini okuhambisana namazinga aphezulu obunzima benkinga yokulutha kwabesifazane (abethule ukwanda okuphezulu kwe le ngxenye engezansi yokuhlonza iqhathaniswa neyamadoda, ehambisana nezifundo zokubumbana ezabikwa ngaphambilini kanye nokuhlaziywa kwephrofayili efihlekile (18, 49).
Ukuhlangana kobulili, ukuqala kanye nobude nobukhulu bobuntu
Iphethini yobudlelwano phakathi kokuqala nobude bokulutha kokuziphatha nobuntu buhlukile ngokuya nge-subtype yokuxilonga nobulili babahlanganyeli. Ku-GD, iminyaka yokuqala yokuqala ihlotshaniswa nokufunwa okuphezulu kwamadoda, okubonakala kuhambisana nocwaningo lwe-etiological kumasampula wesilisa abheka iminyaka yokuqala njengendlela yokulamula phakathi kwamazinga okufuna amasha nama-GD correlates (njengobunzima besifo kanye ne-psychopathology (11).
Ku-CB, ukuqala kokuqala kwakuhlotshaniswa namazinga aphezulu okuxhomekeka kwemivuzo nezikolo eziphansi ekuzenzeni kwabesifazane, kanye nezikolo eziphansi ekugwemeni okulimazayo kanye namazinga aphezulu okuziqondisa nokubambisana emadodeni. Le miphumela ingakhombisa ukuthi abesifazane abahlangabezane nalesi simo bangaphokophela phambili ekufuneni ukuvunyelwa okukhulu futhi baveze ubunzima obukhulu ekubhekaneni nezinkinga noma izimo ezicindezelayo, kuyilapho abesilisa beya kugxila kakhulu ezinhlosweni, besebenza ngokuzethemba futhi bezethemba. Ngaphezu kwalokho, eqenjini le-CB, isikhathi eside sokuphazamiseka kuhlotshaniswa nokuphikelela okuphezulu, ukuqondisa ngokwakho, nokuzithuthukisa, okubonakala kuhambelana nokubonwa ezifundweni ezedlule (50, 51). Njengoba kunikezwe ukuntuleka kwethu kwabesifazane eqenjini laseSA, akunakwenzeka ukwenza ukuzihlanganisa phakathi kobuntu nobuntu kanye nezocansi ezigulini ezinokulutha kokuziphatha. Kungaba wusizo ukuthi izifundo zesikhathi esizayo zifake amasampula ahlukahlukene futhi alinganayo. Futhi, sathola ukuthi isampula yethu yaseNingizimu Afrika yavumela amazinga aphakeme kakhulu wokufuna ukuqhathaniswa neziguli ze-GD, futhi okubaluleke, amazinga aphansi wokuzibamba.
Ukulinganiselwa namandla
Yize sinesayizi enkulu eyisampula (enikeza amandla amakhulu wezibalo zokuhlaziya eziningi nokuqhathanisa), inani leziguli kwamanye amaqembu lalilincane. Ngokunjalo, ngenxa yobudlelwano obusondelene phakathi kokuxhaphaka kokuziphatha ngakunye kokuziphatha kanye nezocansi, ukusatshalaliswa kwabesilisa nabesifazane bekungalingani kakhulu phakathi kwamaqembu. Kufanele kuphakanyiswe, kepha-ke, ukuthi isampula yayihlanganisa zonke iziguli ezazilandela i-unit yokwelashwa ezilandelanayo futhi zahlangabezana nenqubo yokufaka / yokufakelwa ngaphandle, futhi ngenxa yalokho ukwabiwa kobulili kuyahambelana nobuningi lapho lezi zinkinga zenzeka ezweni lethu (52), enikeza ukuqina okuphezulu kwangaphandle emiphumeleni yethu.
Ngakolunye uhlangothi, lo msebenzi uhlose ukwazi ubulili beziguli, ubudala, nobude besifo bufaka isandla ngokukhethekile ekuluthweni kwemikhuba yokuziphatha ebhalisa ukwanda okuphezulu kakhulu esikhungweni sezempilo esikhethekile eSpain, futhi ngenxa yalokho amaqembu ahlukehlukene ahlaziyiwe. Ucwaningo lwesikhathi esizayo kumele lwenzelwe ukuhlaziya umnikelo walezi zinto eziguqukayo kuphrofayela yomtholampilo weziguli ezethula umkhuba wokuziphatha ohambisanayo-we-comorbid.
Amandla amabili ocwaningo lwethu usayizi omkhulu wesampula nokufakwa kwamaqembu ahlukahlukene ezifundo ezihlangabezana nenqubo yokuxilonga ye-BA ehlukile. Amanye amandla afanele ukufakwa kanye nokuhlaziywa kwezindlela eziningi zokusebenza kwengqondo, ezihlanganisa ubucayi be-BA, isimo sezengqondo nezimpawu zobuntu.
Imithelela
Imiphumela yalolu cwaningo inikezela ngobufakazi obusha obumayelana nengxenye yobuningi bemilutha yokuziphatha, lapho umnikelo wezinto eziguqukayo njengobudala bokuqala, ubude besifo noma izici zobuntu okufanele zidlale indima yokwehluka kuye ngohlobo lokuxilonga kanye neziguli ' ucansi. Imiphumela yethu ingaba wusizo ekuhloleni izifundo zesikhathi esizayo imodeli yokuhlanganisa yokuchaza izindlela ezisemqoka eziholela ekuqaleni nasekuthuthukisweni kokuxilongwa kokulutha kokuziphatha ngakunye. Njengasezinqubweni eziningi eziyinkimbinkimbi, ezinamacala amaningi, izifundo ezengeziwe ezindaweni ezahlukahlukene ziyadingeka: ucwaningo lwe-etiological (ngokwesibonelo izifundo zezinzwa ukubona ukuthi yiziphi izifunda ezithile, amanethiwekhi, nemisebenzi ephezulu / yokuqonda ebandakanyekayo), kanye nezifundo zokwelashwa (ukukhomba okuphelele ama-phenotypes kanye ne-trajectories yentuthuko yesimo ngasinye sokuxilongwa). Ekugcineni, ukuqonda okuningiliziwe kwe-etiologically kanye nenkambo yokwakhiwa kokulutha kokuziphatha, kanye nezimbangela eziyisisekelo zokuhluka kwayo, kuzovumela ukwenza ngcono imizamo yokuvikela nokwelashwa. Ukunakekelwa okukhethekile kufanele kukhokhelwe ekunikelweni kwezici zenhlalo-yabantu, futhi ikakhulukazi kwezocansi okubonakala ngathi kuneqhaza eliyinkimbinkimbi esimweni somtholampilo weziguli ngokuya ngokuhlukahluka kwangaphandle. Izinsizakalo zokuvikela ezempilo yengqondo nezokungenelela zizoba yinzuzo ukwenza amathuluzi wokuhlola nokuhlola anamandla aphezulu okubandlulula ohlokweni ngalunye lokuxilonga, kanye nokuhlinzeka ngezinhlelo zokungenelela ezilawula ngokwanele ama-phenotypes athile. Lokhu kusebenza ikakhulukazi kwezinye izinhlobo zokulutha kokuziphatha, lapho kunamathuluzi ambalwa wokulinganisa nezinhlelo zokwelashwa ezijwayelekile ezinomkhawulo (njenge-CB noma i-SA).
Umnikelo wombhali
I-SV-S, RG, FF-A, JM, ne-SJ-M baklame lo msebenzi wokuhlola ngokusekelwe emiphumeleni yangaphambilini nesipiliyoni somtholampilo se-NM-B, NA, MG-P, AdP-G, MB, ne-LM. AbakwaSV-S, RG, VM-R, GM-B, TS, FF-A, kanye no-SJ-M baqhuba lo msebenzi, bahlaziya imininingwane, babhala nokubhalwa kokuqala kombhalo wesandla. I-SJ-M, i-TS, i-GM-B, i-RG, kanye ne-FF-i yaguqula umbhalo wesandla.
Ukungqubuzana kwesitatimende senzuzo
Abalobi bamemezela ukuthi ucwaningo lwaluqhutshwa ngokungabikho kobudlelwane bezohwebo noma zezimali ezingase zithathwe njengokungqubuzana okungase kube khona.
Ukuvuma
Ukuxhaswa kwezezimali kutholwe ngeMinisterio de Economía y Competitividad (nikeza i-PSI2011-28349 kanye ne-PSI2015-68701-R). I-FIS PI14 / 00290, FIS PI17 / 01167, kanye ne-18MSP001-2017I067 ithole usizo kuMinisterio de Sanidad, uSericios Sociales e Igualdad. ICIBER Fisiología Obesidad y Nutrición (CIBERobn) noCIBER Salud Mental (CIBERSAM), womabili angamanyathelo we-ISCIII. I-GMB isekelwa yisibonelelo sika-AGAUR sangaphambi kokubhaliswa (i-2018 FI_B2 00174), inikezwe uxhaso oluxhaswe yi-European Social Fund (ESF) "ESF", investing in your future. Ngokusekelwa kwehhovisi Lobunobhala BamaNyuvesi kanye Nocwaningo loMnyango Wezamabhizinisi Nolwazi ngoHulumeni waseCatalonia. Silubonga kakhulu uhlelo lweCERCA kanye neGeneralitat de Catalunya ngokuxhaswa kwezikhungo. Sibonga futhi i-Fondo Europeo de Desarrollo Regional (FEDER) nohlelo lwabo, “Una manera de hacer Europa” (Indlela Yokwakha iYurophu).
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