KISEP Original Article J Korean Neuropsychiatr Assoc Vol 43, No 4 한국정신장애의역학조사연구 (I): 각정신장애의유병률 서울대학교의과대학정신과학교실, 1 가천의과대학교정신과학교실, 2 국립서울정신병원, 3 한국보건사회연구원, 4 을지대학교의과대학정신과학교실, 5 울산대학교의과대학정신과학교실, 6 성안드레아신경정신병원, 7 서울시립은평병원정신과, 8 인제대학교의과대학정신과학교실, 9 인하대학교의과대학정신과학교실, 10 연세대학교원주의과대학정신과학교실, 11 충북대학교의과대학신경정신과학교실, 12 대구가톨릭대학교의과대학정신과학교실, 13 국립나주병원정신과, 14 한국음주문화연구센터 15 조맹제 1 함봉진 2 김장규 1 박강규 3 정은기 3 서동우 4 김선욱 50 조성진 20 이준영 1 홍진표 6 최용성 7 박종익 8 이동우 9 이기철 9 배재남 10 신정호 11 정인원 12 박종한 13 배안 14 이충경 15 Korean Epidemiologic Catchment Area(KECA) Study for Psychiatric Disorders: Prevalence of Specific Psychiatric Disorders Maeng Je Cho, MD 1, Bong-Jin Hahm, MD 2, Jang-Kyu Kim, MD 1, Kang-Kyu Park, MD 3, Eun-Kee Chung, MD 3, Tong Woo Suh, MD 4, Seon-Uk Kim, MD 5, Seong-Jin Cho, MD 2, Jun-Young Lee, MD 1, Jin-Pyo Hong, MD 6, Yong-Seoung Choi, MD 7, Jong-Ik Park, MD 8, Dong-Woo Lee, MD 9, Gi-Chul Lee, MD 9, Jae-Nam Bae, MD 10, Jong-Ho Shin, MD 11, In-Won Chung, MD 12, Jong Han Park, MD 13, Ahn Bae, MD 14 and Choong-Koung Lee, MD 15 Department of Psychiatry, 1 Seoul National University College of Medicine, Seoul, Department of Psychiatry, 2 Gachon Medical School, Incheon, Seoul National Mental Hospital, 3 Seoul, Korea Institute of Health and Social Affairs, 4 Seoul, Department of Psychiatry, 5 Eulji University School of Medicine, Seoul, Department of Psychiatry, 6 Ulsan University College of Medicine, Seoul, St. Andrew s Neuropsychiatric Hospital, 7 Icheon, Department of Psychiatry, 8 Seoul Metropolitan Eunpyoung Hospital, Seoul, Department of Psychiatry, 9 College of Medicine, Inje University, Seoul, Department of Psychiatry, 10 College of Medicine, Inha University, Incheon, Department of Psychiatry, 11 Yonsei University Wonju College of Medicine, Wonju, Department of Neuropsychiatry, 12 College of Medicine, Chungbuk National University, Cheongju, Department of Psychiatry, 13 Catholic University of Daegu School of Medicine, Daegu, Department of Psychiatry, 14 Naju National Hospital, Naju, Korean Alcohol Research Foundation, 15 Seoul, Korea Objectives:This study aims to estimate the prevalence of the DSM-IV psychiatric disorders in Korean population using the Korean version of Composite International Diagnostic Interview (K-CIDI). Methods:Subjects were selected by taking multi-stage, cluster samples of 7,867 adult household residents, 18 to 64 years of age, in ten catchment areas. Total 78 trained interviewers administered the K-CIDI to the selected respondents, from June 1 to November 30, 2001. Results:Total 6,275 respondents completed the interview. Some 33.5% of respondents reported at least one lifetime disorder, 20.6% reported at least one-year disorder, and 16.7% reported at least one-month disorder. The most common lifetime disorders were alcohol abuse/dependence (17.24%), nicotine dependence/withdrawal (11.19%), specific phobia (5.16%), and major depressive disorder (4.25%). The lifetime prevalence of substance abuse/dependence (0.25%) and schizophrenia (0.16%) was very low. Nicotine and alcohol use disorder showed very high male/female ratio. Mood disorder and anxiety disorder were more prevalent among female than male. Conclusion:The prevalence of psychiatric disorders was high. In comparison with other studies, remarkable differences in distributions of psychiatric disorders across the areas and times were observed. (J Korean Neuropsychiatr Assoc 2004;43(4): 470-480) KEY WORDS:Prevalence Epidemiology Psychiatric disorder K-CIDI. 470
서론 - - 연구방법 조사도구개발 훈련센터설립 조사지역및연구진선정 예비조사 471
Table 1. Catchment areas and research centers for Korean Epidemiologic Catchment Area study for psychiatric disorders Catchment area Seoul East Gwangjin-gu West Eunpyoung-gu South Songpa-gu, Kangdong-gu North Nowon-gu Incheon Jung-gu Kangwha-gun Chungcheongbuk-do Cheongwon-gun Kyungsangbuk-do Daegu Chenlanam-do Naju Kangwon-do Wonju Center Seoul National Mental Hospital Seoul Metropolitan Eunpyoung Hospital Ulsan University Seoul National University Inha University Gacheon Medical School Chungbuk National University Catholic University of Daegu Naju National Hospital Yonsei University Wonju 1 Seoul East (Gwangjin-gu) 2 Seoul West (Enpyoung-gu) 3 Seoul South (Songpa-gu, Kangdong-gu) 4 Seoul North (Nowon-gu) 5 Incheon Jung-gu 6 4 2 1 3 5 7 10 6 Incheon Kangwha-gun 7 Chungcheongbuk-do Cheongwon-gun 8 Kyungsangbuk-do Daegu 9 Chenlanam-do Naju 8 10 Kangwon-do Wonju 9 Fig. 1. Location of sampling areas. 표본추출 - 472
본조사 사전준비 조사요원선발및교육 가정방문및면담 가정방문결과처리 자료정리및분석 연구결과 반응율및반응자의인구학적특성 Table 2. Age and sex distribution of the respondents Age years Male Female Total No % %* No % %* No % %* 1829 0.556 020.2 031.3 0.692 019.6 030.6.1248 019.9 031.0 3039 0.776 028.2 027.7 1,043 029.6 027.1.1819 029.0 027.4 4049 0.682 024.8 022.3 0.751 021.3 022.1.1433 022.8 022.2 5059 0.431 015.7 013.4 0.541 015.4 014.1.0972 015.5 013.7 6064 0.306 011.1 005.1 0.497 014.1 006.1.0803 012.8 005.6 Total 2,751 100.0 100.0 3,524 100.0 100.0 6,275 100.0 100.0 Age and sex distribution of general population 2000 census data 473
정신장애의평생유병률 Table 3. Lifetime prevalence of psychiatric disorders by sex, weighted to the general population Diagnoses Male Female Total % SE % SE % SE Nicotine dependence/withdrawal 20.76 1.31 01.90 0.33 11.19 0.75 Nicotine dependence 19.00 1.31 01.79 0.32 10.27 0.71 Nicotine withdrawal 05.35 0.50 00.43 0.16 02.85 0.29 Alcohol abuse/dependence 28.38 1.83 06.42 0.70 17.24 1.07 Alcohol abuse 12.58 0.86 01.79 0.57 07.11 0.50 Alcool dependence 15.97 1.46 04.64 0.57 10.20 0.89 Substance use disorder 00.33 0.15 00.18 0.09 00.25 0.08 Substance abuse 00.28 0.15 00.13 0.09 00.20 0.09 Substance dependence 00.04 0.04 00.05 0.04 00.05 0.03 Mood disorder 02.67 0.57 06.89 0.43 04.81 0.35 Major depressive disorder 02.57 0.56 05.89 0.48 04.25 0.36 Dysthymic disorder 00.06 0.04 00.92 0.21 00.50 0.11 Bipolar disorder 00.04 0.03 00.28 0.13 00.16 0.07 Psychotic disorder 00.74 0.25 01.63 0.34 01.19 0.20 Schizophrenia 00.08 0.06 00.24 0.11 00.16 0.07 Schizophreniform disorder 00.13 0.07 00.12 0.06 00.12 0.06 Schizoaffective disorder 0.00 0 0.00 0 0.00 0 Delusional disorder 0.00 0 00.07 0.07 00.04 0.04 Brief psychotic disorder 00.54 0.25 01.19 0.27 00.87 0.17 Anxiety disorders 04.95 0.54 13.14 0.99 09.11 0.62 Panic disorder 00.07 0.07 00.72 0.22 00.40 0.12 Specific phobia 02.43 0.40 07.82 1.05 05.16 0.65 Social phobia 00.08 0.06 00.35 0.10 00.22 0.06 Obsessive-compulsive disorder 00.62 0.22 01.04 0.26 00.83 0.14 Posttraumatic stress disorder 00.86 0.21 02.54 0.41 01.71 0.27 Generalized anxiety disorder 01.19 0.29 03.37 0.38 02.30 0.24 Somatoform disorder 00.27 0.13 01.00 0.23 00.64 0.14 Somatization disorder 0.00 0 00.01 0.01 0.00 0 Conversion disorder 00.12 0.11 00.54 0.15 00.33 0.10 Pain disorder 00.04 0.02 00.34 0.15 00.19 0.08 Hypochondriasis 00.11 0.02 00.23 0.10 00.17 0.06 Eating disorder 00.19 0.10 00.18 0.10 00.19 0.07 Anorexia nervosa 00.19 0.10 00.13 0.08 00.16 0.06 Bulimia nervosa 0.00 0 00.06 0.05 00.03 0.02 Any diagnoses 43.65 2.30 23.57 1.00 33.46 1.31 Any diagnoses except nicotine disorders 33.41 2.08 22.82 1.09 28.03 1.22 Any diagnoses except nicotine & alcohol disorders 07.97 0.76 18.73 0.91 13.43 0.65 SEstandard error, Exclusion criteria operationalized 474
정신장애의일년유병률 Table 4. One-year prevalence of psychiatric disorders by sex, weighted to the general population Diagnoses Male Female Total % SE % SE % SE Nicotine dependence/withdrawal 13.66 1.25 01.23 0.32 07.35 0.71 Nicotine dependence 12.11 1.28 01.16 0.30 06.54 0.70 Nicotine withdrawal 03.62 0.57 00.10 0.05 01.83 0.30 Alcohol abuse/dependence 11.89 1.08 02.50 0.33 07.11 0.64 Alcohol abuse 03.46 0.59 00.58 0.18 02.00 0.32 Alcool dependence 08.39 0.80 01.92 0.36 05.09 0.49 Mood disorder 00.90 0.26 03.22 0.41 02.07 0.24 Major depressive disorder 00.84 0.25 02.45 0.37 01.65 0.24 Dysthymic disorder 00.05 0.03 00.64 0.20 00.35 0.10 Bipolar disorder 00.01 0.01 00.28 0.13 00.14 0.07 Psychotic disorder 00.22 0.10 00.80 0.25 00.51 0.15 Schizophrenia 00.08 0.06 00.24 0.11 00.16 0.07 Schizophreniform disorder 00.02 0.02 00.12 0.06 00.07 0.03 Schizoaffective disorder 00.00 00 00.00 00 0.00 0 Delusional disorder 00.00 00 00.07 0.07 00.04 0.04 Brief psychotic disorder 00.11 0.08 00.37 0.16 00.24 0.10 Anxiety disorders 02.93 0.29 09.38 0.88 06.20 0.49 Panic disorder 00.07 0.07 00.29 0.12 00.19 0.08 Specific phobia 01.67 0.25 06.59 0.89 04.17 0.45 Social phobia 00.08 0.06 00.23 0.09 00.16 0.06 Obsessive-compulsive disorder 00.47 0.21 00.70 0.22 00.58 0.12 Posttraumatic stress disorder 00.07 0.04 01.26 0.31 00.68 0.17 Generalized anxiety disorder 00.65 0.22 01.42 0.34 01.04 0.26 Somatoform disorder 00.24 0.13 00.72 0.20 00.49 0.13 Somatization disorder 00.00 00 00.01 0.01 0.00 0 Conversion disorder 00.12 0.11 00.37 0.15 00.25 0.11 Pain disorder 00.03 0.02 00.19 0.10 00.11 0.05 Hypochondriasis 00.10 0.06 00.17 0.07 00.13 0.05 Eating disorder 00.00 00 00.07 0.05 00.03 0.02 Anorexia nervosa 00.00 00 00.05 0.05 00.03 0.02 Bulimia nervosa 00.00 00 00.02 0.01 00.01 0.01 Any diagnoses 26.23 1.77 15.17 0.96 20.64 1.16 Any diagnoses except nicotine disorders 15.80 1.20 14.31 1.00 15.04 0.89 Any diagnoses except nicotine & alcohol disorders 04.44 0.41 12.50 0.96 08.51 0.55 SEstandard error, Exclusion criteria operationalized 475
정신장애의일개월유병률 Table 5. One-month prevalence of psychiatric disorders by sex, weighted to the general population Diagnoses Male Female Total % SE % SE % SE Nicotine dependence/withdrawal 10.92 1.13 01.23 0.32 06.00 0.69 Nicotine dependence 09.37 1.02 01.15 0.30 05.20 0.61 Nicotine withdrawal 03.30 0.57 00.10 0.05 01.68 0.30 Alcohol abuse/dependence 08.25 0.78 01.38 0.26 04.75 0.48 Alcohol abuse 02.02 0.35 00.39 0.16 01.20 0.20 Alcool dependence 06.20 0.61 00.98 0.23 03.54 0.35 Mood disorder 00.48 0.16 02.17 0.24 01.33 0.15 Major depressive disorder 00.44 0.16 01.79 0.27 01.12 0.17 Dysthymic disorder 00.03 0.01 00.46 0.15 00.25 0.08 Bipolar disorder 00.01 0.01 00.27 0.13 00.14 0.07 Psychotic disorder 00.18 0.10 00.60 0.24 00.39 0.14 Schizophrenia 00.08 0.06 00.24 0.11 00.16 0.07 Schizophreniform disorder 00.01 0.01 00.09 0.05 00.05 0.03 Schizoaffective disorder 0.00 0 0.00 0 0.00 0 Delusional disorder 0.00 0 0.00 0 0.00 0 Brief psychotic disorder 00.09 0.07 00.28 0.16 00.18 0.09 Anxiety disorders 02.48 0.23 08.24 0.77 05.40 0.42 Panic disorder 00.01 0.01 00.17 0.08 00.09 0.04 Specific phobia 01.62 0.26 05.77 0.74 03.73 0.40 Social phobia 00.06 0.05 00.21 0.08 00.13 0.05 Obsessive-compulsive disorder 00.34 0.20 00.67 0.22 00.51 0.13 Posttraumatic stress disorder 00.07 0.04 01.13 0.25 00.61 0.14 Generalized anxiety disorder 00.46 0.22 01.19 0.28 00.83 0.23 Somatoform disorder 00.24 0.13 00.66 0.18 00.45 0.12 Somatization disorder 0.00 0 00.01 0.01 0.00 0 Conversion disorder 00.12 0.11 00.37 0.15 00.25 0.11 Pain disorder 00.03 0.02 00.15 0.07 00.09 0.04 Hypochondriasis 00.10 0.06 00.15 0.07 00.12 0.04 Eating disorder 0.00 0 00.02 0.01 00.01 0.01 Anorexia nervosa 0.00 0 0.00 0 0.00 0 Bulimia nervosa 0.00 0 00.02 0.01 00.01 0.01 Any diagnoses 20.78 1.57 12.72 0.82 16.70 0.96 Any diagnoses except nicotine disorders 11.80 0.90 11.78 0.82 11.79 0.59 Any diagnoses except nicotine & alcohol disorders 03.63 0.34 10.77 0.82 07.23 0.44 SEstandard error, Exclusion criteria operationalized 476
고찰 - 477
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결 론 중심단어 REFERENCES 1) Regier DA, Burke J. Epidemiology. In: Kaplan HI, Sadock BJ, editors. Comprehensive Textbook of Psychiatry, 7th ed. Baltimore: WIlliams & Wilkins;2000. p.500-521. 2) Robins LN, Helzer JE, Croughan J, Ratcliff KS. National Institute of Mental Health Diagnostic Interview Schedule: Its History, Characteristics, and Validity. Arch Gen Psychiatry 1981;38:381-389. 3) Regier DA, Myers JK, Kramer M, Robins LN, Blazer DG, Hough RL, et al. The NIMH epidemiologic catchment area program. Arch Gen Psychiatry 1984;41:934-941. 4) Robins LN. Psychiatric Epidemiology-a historic review. Soc Psychiatry Psychiatr Epidemiol 1990;25:16-26. 5) Aderibigbe YA, Adityanjee SK. Psychiatric epidemiology in cross-cultural perspective: a review. Eur Arch Psychiatry Clin Neurosci 1995; 246:37-46. 6) Lee CK, Kwak YS, Yamamoto J, Rhee H, Kim YS, Han JH, et al. Psychiatric epidemiology in Korea, Part I: Gender and age differences in seoul. J Ner Ment Dis 1990;178:242-246. 7) Lee CK, Kwak YS, Yamamoto J, Rhee H, Kim YS, Han JH, et al. Psychiatric epidemiology in Korea, Part II: Urban and rural differences. J Ner Ment Dis 1990;178:247-252. 8) 이호영, 남궁기, 이만홍, 민성길, 김수영, 송동호등. 강화도정신과역학연구 (III)- 주요정신질환의평생유병률. 신경정신의학 1989;28:984-999. 9) Bland RC, Newman SC, Orn H. Epidemiology of psychiatric disorders in Edmonton. Acta Paychiatr Scand 1988;77(Suppl 338):1-80. 10) Wittchen HU, Essau CA, Von-Zerssen D, Krieg JC, Zaudig M. A lifetime and six-month prevalence of mental disorders in the Munich follow-up study. Eur Arch Psychiatry Clin Neurosci 1992;241:247-258. 11) Chen CN, Wong J, Lee N, Chan-Ho MW, Lau JT, Fung M, et al. The Shatin community mental health survey in Hong Kong, Major findings. Arch Gen Psychiatry 1993;50:125-133. 12) Stefansson JG, Lindal E, Bjomsson JK, Gudmundsdotter A. The lifetime prevalence of specific mental disorders among persons born in Iceland in 1931. Acta Psychiatr Scand 1991;84:142-149. 13) Wells JE, Bushnell JA, Hornblow AR, Joyce PR, Oakley-Browne MA. Christchurch psychiatric epidemiology study part I: methodology and lifetime prevalence for specific psychiatric disorders. Aust NZJ Psychiatry 1989;23:315-326. 14) Hwu HG, Yeh EK, Chang LY. Prevalence of psychiatric disorders in Taiwan defined by the Chinese diagnostic interview schedule. Acta Psychiatr Scand 1989;79:136-147. 15) Helzer JE, Canino GJ. Alcoholism in North America, Europe, and Asia. New York: Oxford University Press;1992. 16) Robins LN, Wing J, Wittchen HU, Helzer JE, Babor TF, Burke J, et al. The Composite International Daignostic Interview. Arch Gen Psychiatry 1988;45:1069-1077. 17) Wittchen HU, Robins LN, Cottler LB, Sartorius N, Burke JD, Regier D. Cross-cultural feasibility, reliability and sources of variance of the Composite International Diagnostic Interview (CIDI). Br J Psychiatry 1991;159:645-653. 18) Andrews G, Peters L. The psychometric properties of the Composite International Diagnostic Interview. Soc Psychiatry Psychiatr Epidemiol 1998;33:80-88. 19) Kessler RC, McGonagle K, Zhao S, Nelson CB, Hughes M, Eshleman S, et al. Lifetime and 12-Month Prevalence of DSM-III-R Psychiatric Disorders in the United States. Arch Gen Psychiatry 1994;51:8-19. 20) WHO International Consortium in Psychiatric Epidemiology. Crossnational comparisons of the prevalences and correlates of mental disorders. Bull World Health Organ 2000;78:413-426. 21) Bijl RV, Ravelli A, van Zessen G. Prevalence of psychiatric disorder in the general population: results of the Netherlands Mental Health Survey and Incidence Study (NEMESIS). Soc Psychiatry Psychiatr Epidemiol 1998;33:587-595. 22) Offord DR, Boyle MH, Campbell D, Goering P, Lin E, Wong M, et al. One-year Prevalence of Psychiatric Disorder in Ontarians 15 to 64 479
Years of Age. Can J Psychiatry 1996;41:559-563. 23) Andrews G, Henderson S, Hall W. Prevalence, comorbidity, disability and service utilisation. Overview of the Australian National Mental Health Survey. Br J Psychiatry 2001;178:145-53. 24) 조맹제, 함봉진, 서동우, 홍진표, 배재남, 김장규등. 한국어판 Composite International Diagnostic interview (K-CIDI) 의개발. 신경정신의학 2002;41:123-137. 25) 이정균, 김용식, 한진희, 최진옥. 한국정신장애의역학적조사연구 (VII): 한국어판 DIS-III 의제작. 서울의대정신의학부록 1986;11:235-242. 26) 이정균, 곽영숙, 이희등. 한국정신장애의역학적조사연구 (I): 도시및시골지역의평생유병률. 서울의대정신의학부록 1986;11:121-141. 27) 이정균, 이희, 김용식등. 한국정신장애의역학적조사연구 (II): 서울지역. 서울의대정신의학부록 1986;11:142-161. 28) 이정균, 곽영숙, 김용식등. 한국정신장애의역학적조사연구 (III): 시골지역. 서울의대정신의학부록 1986;11:162-189. 29) Helzer JE, Canino GJ, Yeh EK, Bland RC, Lee CK, Hwu HG, et al. Alcoholism-North America and Asia. Arch Gen Psychiatry 1990;47: 313-319. 30) Weissman MM, Bland RC, Canino GJ, Greenwald S, Hwu HG, Lee CK, et al. The cross national epidemiology of obsessive compulsive disorder. J Clin Psychiatry 1994;55(Suppl 3):5-10. 31) Weissman MM, Bland RC, Canino GJ. Women s increased vulnerability to major depression: cross-national perspectives. WPA teaching Bulletin on Depression 1994;2:1-3. 32) Weissman MM, Canino GJ, Greenwald S, et al. Current rates and symptom profiles of panic disorder in six cross-national studies. Clinical Neuropharmacology 1995;18(Suppl 2):S1-S6. 33) Weissman MM, Bland RC, Canino GJ, Greenwald S, Lee CK, Newman SC. The cross-national epidemiology of social phobia: a preliminary report. Int J Clinical Psychopharmacology 1996;11(Suppl 3):9-14. 34) Weissman MM, Bland RC, Canino GJ, Faravelli C, Hwu HG, Joyce PR. Cross-national epidemiology of major depression and bipolar disorder. JAMA 1996;276:293-299. 35) 함봉진, 조맹제. 남양주시일반인구에서정신장애의유병률. 신경정신의학 2002;41:713-724. 36) 조맹제, 함봉진. 한국어판 Composite International Diagnostic interview (K-CIDI). 서울 : 한국가이던스 ;2000. 37) World Health Organization. Composite International Diagnostic Interview (CIDI) Core version 2.1. Geneva: World Health Organization; 1997 38) World Health Organization. Procedures for the Development of New Language Versions of the WHO Composite International Diagnostic Interview (WHO-CIDI), electronic version. Geneva: World Health Organization;1998. 39) World Health Organization. Composite International Diagnostic Interview (CIDI) Core version 2.1 Trainer s Manual. Geneva: World Health Organization;1997. 40) American Psychiatric Association. Diagnostic and Statistical Manual of Mental disorders, 4th ed, Washington, DC;1994. 41) 통계청. 총조사인구총괄 ( 행정구역 / 성 / 연령별 ). Available from URL: http://kosis.nso.go.kr/cgi-bin/sws_999.cgi. 42) SPSS Inc. SPSS;1999. 43) Research Triangle Institute. SUDAAN user s manual, release 8.0. Research Triangle Park, NC. Research Triangle Institute;2000. 44) American Psychiatric Association. Diagnostic and Statistical Manual of Mental disorders, 3rd ed, Washington, DC;1980. 45) World Health Organization. Composite International Diagnostic Interview (CIDI), version 1.1. Geneva: World Health Organization;1997. 46) American Psychiatric Association. Diagnostic and Statistical Manual of Mental disorders, 3rd ed. Revised, Washington, DC;1987. 47) Bucholz KK. Nosology and epidemiology of addictive disorders and their comorbidity. Psychiatr Clin North Am 1999;22:221-240. 480