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Article(id=1325500982519530441, tenantId=1146029695717560320, journalId=1256213402557890569, issueId=1325500677975318675, articleNumber=null, orderNo=null, doi=10.16835/j.cnki.1000-9817.2025041, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1729526400000, receivedDateStr=2024-10-22, revisedDate=1732723200000, revisedDateStr=2024-11-28, acceptedDate=null, acceptedDateStr=null, onlineDate=1793953660850, onlineDateStr=2026-11-06, pubDate=1740412800000, pubDateStr=2025-02-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793953660850, onlineIssueDateStr=2026-11-06, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793953660850, creator=13701087609, updateTime=1793953660850, updator=13701087609, issue=Issue{id=1325500677975318675, tenantId=1146029695717560320, journalId=1256213402557890569, year='2025', volume='46', issue='2', pageStart='153', pageEnd='304', issueExtLink='null', onlineDate='null', pubDate='1740412800000', pubDateStr='2025-02-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793953588241, creator='13701087609', updateTime=1793953588241, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=266, endPage=271, ext={EN=ArticleExt(id=1325500982783771594, articleId=1325500982519530441, tenantId=1146029695717560320, journalId=1256213402557890569, language=EN, title=Analysis of disease burden for bipolar disorder in Chinese adolescents aged 10-24 years and trend prediction, columnId=1325500884406379444, journalTitle=Chinese Journal of School Health, columnName=Disease Control, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the burden of bipolar disorder among adolescents aged 10-24 in China from 1990 to 2021 and its trend of change, so as to provide theoretical basis for the prevention and treatment of bipolar disorder.

Methods

The latest data from the Global Burden of Disease (GBD) database in 2021 were selected. The Joinpoint regression model, age-period-cohort (APC) model, and bayesian age-period-cohort (BAPC) model were used to analyze and predict indicators such as the age-standardized incidence rate and age-standardized disability-adjusted life year (DALY) rate of bipolar disorder among Chinese adolescents, and the average annual percent change (AAPC) was calculated.

Results

From 1990 to 2021, the overall age-standardized incidence rate (1990:22.92/100 000, 2021:23.17/100 000) showed an upward trend (AAPC=0.03, t=8.20, P < 0.01) and change trend of age-standardized DALY rate (1990:33.61/100 000, 2021:33.76/100 000) was relatively flat (AAPC=0.01, t=0.99, P=0.32). From 1990 to 2021, age-standardized incidence rate and age-standardized DALY rate of girls were higher than boys (χ2=16.38, P < 0.01). The net drift values for the incidence rate and DALY rate of bipolar disorder among Chinese adolescents aged 10-24 years were -0.23% and -0.22%, respectively. The highest incidence rate of bipolar disorder among Chinese adolescents aged 10-24 years was observed in the 15-19 age group, with a rate of 33.14/100 000; the highest DALY risk was in the 20-24 age group, with a rate of 57.26/100 000. The lowest incidence risk and DALY risk RR values for bipolar disorder among Chinese adolescents aged 10-24 years were observed in 2017-2021, with RR values of 0.99 (95%CI=0.97-1.00) and 0.98 (95%CI=0.97-0.99), respectively (P < 0.05). Similarly, the lowest incidence risk and DALY risk RR values for this age group were observed in the 2000-2004 birth cohort, both of which were 0.86 (95%CI=0.84-0.87) (P < 0.05). It was projected that the overall age-standardized incidence rate and age-standardized DALY rate of bipolar disorder among Chinese adolescents aged 10-24 years will continue to increase from 2022 to 2031, reaching 24.10/100 000 and 34.90/100 000, respectively, by 2031.

Conclusions

From 1990 to 2021, both the age-standardized incidence rate and age-standardized DALY rate of bipolar disorder among Chinese adolescents shows an upward trend. Special attention should be given to female adolescents, with a focus on controlling the age-standardized incidence rate of bipolar disorder among 15-19 year-old adolescents and the age-standardized DALY rate among 20-24 year-old ones. Efforts should be enhanced to increase awareness and screening for bipolar disorder among adolescents.

, authors=Zihe ZHAO, Jiawen ZHU, Qianling HUANG, Zhi ZENG*, authorsList=Zihe ZHAO, Jiawen ZHU, Qianling HUANG, Zhi ZENG, authorCompany=null, correspAuthors=Zhi ZENG, authorNote=null, correspAuthorsNote=null, copyrightStatement=Copyright ©2025 Chinese Journal of School Health. All rights reserved., copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1325500987582055378, articleId=1325500982519530441, tenantId=1146029695717560320, journalId=1256213402557890569, language=CN, title=中国10~24岁青少年双相障碍疾病负担现状及趋势分析, columnId=1325500884628677558, journalTitle=中国学校卫生, columnName=疾病控制, runingTitle=null, highlight=null, articleAbstract=
目的

分析1990—2021年中国10~24岁青少年双相障碍疾病负担状况及变化趋势，为双相障碍的防治工作提供理论依据。

方法

选取全球疾病负担(GBD)数据库2021年的最新数据，使用Joinpoint回归模型、年龄—时期—队列(APC)模型和贝叶斯年龄—时期—队列(BAPC)模型对中国青少年双相障碍标化发病率和标化失能调整寿命年(DALY)率等指标进行分析和预测，并计算平均年度变化百分比(AAPC)。

结果

1990—2021年青少年双相障碍疾病总体标化发病率(1990年：22.92/10万，2021年：23.17/10万)呈上升趋势(AAPC=0.03，t=8.20，P < 0.01)，标化DALY率(1990年：33.61/10万，2021年：33.76/10万)变化趋势较为平缓(AAPC=0.01，t=0.99，P=0.32)。1990—2021年女生标化发病率和标化DALY率均大于男生(χ2=16.38，P < 0.01)。1990—2021年中国10~24岁青少年双相障碍发病率和DALY率的净漂移值分别为-0.23%和-0.22%。中国10~24岁青少年双相障碍发病率在15~19岁最高，为33.14/10万；20~24岁DALY率最高，为57.26/10万。中国10~24岁青少年双相障碍发病风险和DALY风险RR值均在2017—2021年达到最低，分别为0.99(95%CI=0.97~1.00)和0.98(95%CI=0.97~0.99)(P值均 < 0.05)。中国10~24岁青少年双相障碍发病风险和DALY风险RR值均在2000—2004年出生队列达到最低，均为0.86(95%CI=0.84~0.87)(P值均 < 0.05)。预计2022—2031年中国10~24岁青少年双相障碍总体标化发病率和标化DALY率均呈上涨趋势，到2031年分别涨至24.10/10万和34.90/10万。

结论

1990—2021年中国青少年双相障碍标化发病率和标化DALY率均呈上涨趋势。应重点关注女性青少年群体，控制15~19岁青少年双相障碍标化发病率和20~24岁青少年双相障碍标化DALY率，增强对青少年双相障碍的关注和筛查。

, authors=赵子赫, 朱嘉雯, 黄倩玲, 曾智*, authorsList=赵子赫, 朱嘉雯, 黄倩玲, 曾智, authorCompany=null, correspAuthors=曾智, authorNote=

赵子赫(2000-)，男，山东潍坊人，在读硕士，主要研究方向为社会医学与卫生事业管理

, correspAuthorsNote=
曾智，E-mail：
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赵子赫(2000-)，男，山东潍坊人，在读硕士，主要研究方向为社会医学与卫生事业管理

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注： A、B为时期效应，C、D为队列效应。

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中国10~24岁青少年双相障碍疾病负担现状及趋势分析
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赵子赫 , 朱嘉雯 , 黄倩玲 , 曾智 *
中国学校卫生 | 疾病控制 2025,46(2): 266-271
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中国学校卫生 |疾病控制 2025 , 46 (2) : 266 -271
中国10~24岁青少年双相障碍疾病负担现状及趋势分析
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赵子赫(2000-)，男，山东潍坊人，在读硕士，主要研究方向为社会医学与卫生事业管理

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赵子赫, 朱嘉雯, 黄倩玲, 曾智*
作者信息
  • 南京中医药大学卫生经济管理学院，江苏 210023
通讯作者:
曾智，E-mail：
作者简介:

赵子赫(2000-)，男，山东潍坊人，在读硕士，主要研究方向为社会医学与卫生事业管理

Analysis of disease burden for bipolar disorder in Chinese adolescents aged 10-24 years and trend prediction
Zihe ZHAO, Jiawen ZHU, Qianling HUANG, Zhi ZENG*
Affiliations
  • School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing (210023), Jiangsu Province, China
出版时间: 2025-02-25 doi: 10.16835/j.cnki.1000-9817.2025041
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摘要
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目的

分析1990—2021年中国10~24岁青少年双相障碍疾病负担状况及变化趋势，为双相障碍的防治工作提供理论依据。

方法

选取全球疾病负担(GBD)数据库2021年的最新数据，使用Joinpoint回归模型、年龄—时期—队列(APC)模型和贝叶斯年龄—时期—队列(BAPC)模型对中国青少年双相障碍标化发病率和标化失能调整寿命年(DALY)率等指标进行分析和预测，并计算平均年度变化百分比(AAPC)。

结果

1990—2021年青少年双相障碍疾病总体标化发病率(1990年：22.92/10万，2021年：23.17/10万)呈上升趋势(AAPC=0.03，t=8.20，P < 0.01)，标化DALY率(1990年：33.61/10万，2021年：33.76/10万)变化趋势较为平缓(AAPC=0.01，t=0.99，P=0.32)。1990—2021年女生标化发病率和标化DALY率均大于男生(χ2=16.38，P < 0.01)。1990—2021年中国10~24岁青少年双相障碍发病率和DALY率的净漂移值分别为-0.23%和-0.22%。中国10~24岁青少年双相障碍发病率在15~19岁最高，为33.14/10万；20~24岁DALY率最高，为57.26/10万。中国10~24岁青少年双相障碍发病风险和DALY风险RR值均在2017—2021年达到最低，分别为0.99(95%CI=0.97~1.00)和0.98(95%CI=0.97~0.99)(P值均 < 0.05)。中国10~24岁青少年双相障碍发病风险和DALY风险RR值均在2000—2004年出生队列达到最低，均为0.86(95%CI=0.84~0.87)(P值均 < 0.05)。预计2022—2031年中国10~24岁青少年双相障碍总体标化发病率和标化DALY率均呈上涨趋势，到2031年分别涨至24.10/10万和34.90/10万。

结论

1990—2021年中国青少年双相障碍标化发病率和标化DALY率均呈上涨趋势。应重点关注女性青少年群体，控制15~19岁青少年双相障碍标化发病率和20~24岁青少年双相障碍标化DALY率，增强对青少年双相障碍的关注和筛查。

双相障碍  /  患病代价  /  失能调整生命年  /  青少年
Objective

To analyze the burden of bipolar disorder among adolescents aged 10-24 in China from 1990 to 2021 and its trend of change, so as to provide theoretical basis for the prevention and treatment of bipolar disorder.

Methods

The latest data from the Global Burden of Disease (GBD) database in 2021 were selected. The Joinpoint regression model, age-period-cohort (APC) model, and bayesian age-period-cohort (BAPC) model were used to analyze and predict indicators such as the age-standardized incidence rate and age-standardized disability-adjusted life year (DALY) rate of bipolar disorder among Chinese adolescents, and the average annual percent change (AAPC) was calculated.

Results

From 1990 to 2021, the overall age-standardized incidence rate (1990:22.92/100 000, 2021:23.17/100 000) showed an upward trend (AAPC=0.03, t=8.20, P < 0.01) and change trend of age-standardized DALY rate (1990:33.61/100 000, 2021:33.76/100 000) was relatively flat (AAPC=0.01, t=0.99, P=0.32). From 1990 to 2021, age-standardized incidence rate and age-standardized DALY rate of girls were higher than boys (χ2=16.38, P < 0.01). The net drift values for the incidence rate and DALY rate of bipolar disorder among Chinese adolescents aged 10-24 years were -0.23% and -0.22%, respectively. The highest incidence rate of bipolar disorder among Chinese adolescents aged 10-24 years was observed in the 15-19 age group, with a rate of 33.14/100 000; the highest DALY risk was in the 20-24 age group, with a rate of 57.26/100 000. The lowest incidence risk and DALY risk RR values for bipolar disorder among Chinese adolescents aged 10-24 years were observed in 2017-2021, with RR values of 0.99 (95%CI=0.97-1.00) and 0.98 (95%CI=0.97-0.99), respectively (P < 0.05). Similarly, the lowest incidence risk and DALY risk RR values for this age group were observed in the 2000-2004 birth cohort, both of which were 0.86 (95%CI=0.84-0.87) (P < 0.05). It was projected that the overall age-standardized incidence rate and age-standardized DALY rate of bipolar disorder among Chinese adolescents aged 10-24 years will continue to increase from 2022 to 2031, reaching 24.10/100 000 and 34.90/100 000, respectively, by 2031.

Conclusions

From 1990 to 2021, both the age-standardized incidence rate and age-standardized DALY rate of bipolar disorder among Chinese adolescents shows an upward trend. Special attention should be given to female adolescents, with a focus on controlling the age-standardized incidence rate of bipolar disorder among 15-19 year-old adolescents and the age-standardized DALY rate among 20-24 year-old ones. Efforts should be enhanced to increase awareness and screening for bipolar disorder among adolescents.

Bipolar disorder  /  Cost of illness  /  Disability-adjusted life year  /  Adolescent
赵子赫, 朱嘉雯, 黄倩玲, 曾智. 中国10~24岁青少年双相障碍疾病负担现状及趋势分析. 中国学校卫生, 2025 , 46 (2) : 266 -271 . DOI: 10.16835/j.cnki.1000-9817.2025041
Zihe ZHAO, Jiawen ZHU, Qianling HUANG, Zhi ZENG. Analysis of disease burden for bipolar disorder in Chinese adolescents aged 10-24 years and trend prediction[J]. Chinese Journal of School Health, 2025 , 46 (2) : 266 -271 . DOI: 10.16835/j.cnki.1000-9817.2025041
正文
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青少年正处在身心巨变的特殊阶段，容易产生精神障碍[1-2]。双相障碍是具有持续性和反复性的精神障碍，主要表现为躁狂、轻躁狂和抑郁的反复发作[3]。双相障碍通常在青少年时期发病，约有60%的双相障碍患者在19岁之前就表现出症状[4]，37.6%的双相障碍出现在13~18岁青少年中[5]。双相障碍是我国6类严重精神障碍之一，有数据显示，中国6~16岁青少年双相障碍患病率为0.70%[6]，13~16岁青少年双相障碍患病率为1.60%[7]。青少年时期发病的双相障碍患者病程更长、预后更差[8]，双相障碍不仅会增加青少年自杀、非自杀性自伤的风险[9]，还会影响青少年的睡眠功能、记忆力和学习能力等[10-11]。青少年双相障碍患者还常伴有其他精神障碍，如注意缺陷多动障碍、焦虑、品行障碍和酒精使用障碍等[12-14]。
双相障碍是对青少年危害最为严重的精神障碍之一[15]。本研究基于全球疾病负担(Global Burden of Disease, GBD)数据库最新数据，分析1990—2021年中国10~24岁青少年双相障碍疾病负担，并预测未来10年趋势，以评估现有防控策略效果，为未来政策的制定提供依据，从而加强青少年双相障碍的预防与治疗。
1　资料来源与方法
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1.1　资料来源
使用GBD数据库公布的2021年最新数据[16]。通过GBD结果检索网站筛选数据，疾病选择“Bipolar disorder”(F30-F31.9, F34.0)；地区选择“China”；年份选择“1990—2021”；度量标准选择“number”“rate”；分析指标选择失能调整寿命年(disability-adjusted life year, DALY)、发病率(incidence)；性别选择“both”“male”和“female”；为方便分析，借鉴马晓梅等[17]研究方法，在“age”中选择“10~24”及“10~14”“15~19”和“20~24”年龄段。使用世界卫生组织公布的标准人口结构对发病率和DALY率进行标准化[18]。
1.2　统计学分析
使用Excel 2021软件对1990—2021年中国10~24岁青少年双相障碍的发病率和DALY率等指标进行描述性统计，并计算发病数和DALY的变化率，发病数变化率=(1990年发病数—2021年发病数)/1990年发病数，DALY变化率公式与之相同[19]。计数资料采用频数和率描述；计量资料符合正态分布的采用(x ± s)表示，组间比较采用方差分析；非正态计量资料采用M(P25，P75)表示，组间比较采用Kruskal-Wallis秩和检验。检验水准为α=0.05。
使用Joinpoint 5.1软件计算标化发病率和标化DALY率的平均年度变化百分比(average annual percent change, AAPC)，表示疾病负担的全局平均变化趋势，AAPC>0表示疾病负担呈上升趋势，AAPC < 0表示疾病负担呈下降趋势[20]。采用t检验对Joinpoint回归模型进行检验，P>0.05为无趋势性。
使用美国国家癌症研究所开发的网页分析工具进行年龄—时期—队列(age-period-cohort, APC)分析。分析工具要求年龄与时期间隔一致，因此将时期也划分为从1992—1996年到2017—2021年的一系列5年时间段(1990和1991年的数据因不足5年，不纳入分析)。时期队列减去年龄得到1970—1974年，1975—1979年，1980—1984年，1985—1989年，1990—1994年，1995—1999年，2000—2004年，2005—2009年8个出生队列。输出结果包括净漂移值、局部漂移值、纵向年龄曲线和时期(队列)率比(rate ratio, RR)。净漂移值是APC对数线性模型中线性时期(或线性队列)的线性趋势系数[21]，表示疾病率随时间推移的总体年度变化百分比，净漂移值>0表示疾病负担呈上升趋势， < 0表示疾病负担呈下降趋势。局部漂移值表示不同年龄组疾病率的年变化百分比，局部漂移值>0表示疾病负担呈上升趋势， < 0表示疾病负担呈下降趋势。纵向年龄曲线表示经过时期偏差调整后的年龄别疾病率，RR表示时期(队列)的相对风险，RR值>1表示相对风险较高， < 1表示相对风险较低，对可估计函数采用Wald χ2检验(双侧)。使用R-BAPC包和R-INLA包进行贝叶斯年龄—时期—队列(Bayesian age-period-cohort, BAPC)分析，对2022—2031年中国10~24岁青少年双相障碍标化发病率和标化DALY率进行预测[22]。
2　结果
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2.1　中国10~24岁青少年1990—2021年双相障碍发病和DALY变化情况
中国10~24岁青少年双相障碍发病数从1990年的8.24万例下降至2021年的5.41万例，减少了34.34%；男生从4.07万例下降至2.80万例，减少了31.20%；女生从4.18万例下降至2.61万例，减少了37.56%。中国10~24岁青少年双相障碍产生的DALY从1990年的12.99万人年降至2021年的7.65万人年，减少了41.11%；男生从6.46万人年下降至3.98万人年，减少了38.39%；女生从6.52万人年下降至3.67万人年，减少了43.71%。
1990—2021年中国10~24岁青少年双相障碍标化发病率从22.92/10万升至23.17/10万，平均每年上升0.03%(AAPC=0.03，t=8.20，P < 0.01)；1990—2021年中国男生和女生双相障碍标化发病率分别从22.05/10万，23.84/10万升至22.44/10万，24.02/10万，平均每年上升0.06%和0.02%(AAPC值分别为0.06，0.02，t值分别为7.29，5.97，P值均 < 0.01)。中国10~24岁青少年双相障碍标化DALY率1990年为33.61/10万，2005年升至34.50/10万，到2021年降至33.76/10万，1990—2021年变化趋势较为平缓(AAPC=0.01，t=0.99，P=0.32)；1990—2021年中国男生和女生双相障碍标化DALY率分别从32.64/10万，34.63/10万升至32.95/10万，34.68/10万；男生平均每年上升0.03%(AAPC=0.03，t=2.56，P < 0.01)，女生变化趋势较为平缓(AAPC=0.01，t=0.08，P=0.94)。1990—2021年女生标化发病率和标化DALY率均大于男生(χ2=16.38，P < 0.01)。见图1。
2.2　中国10~24岁青少年双相障碍发病率和DALY率APC模型分析
Wald χ2检验结果显示，中国10~24岁青少年双相障碍发病率和DALY率的APC模型结果均有统计学意义(χ2=13.21~37 386.01，P值均 < 0.05)。1990—2021年中国青少年双相障碍发病率和DALY率的净漂移值分别为-0.23%和-0.22%，男生双相障碍发病率和DALY率的净漂移值均为-0.27%，女生双相障碍发病率和DALY率净漂移值分别为-0.18%和-0.16%。总体、男生、女生的发病率和DALY率局部漂移值均在15~19岁年龄段达到最小值，发病率局部漂移值分别为-0.44%，-0.44%，-0.42%；DALY率局部漂移值分别为-0.43%，-0.44%，-0.41%。
年龄效应显示，总体、男生和女生发病率均在15~19岁年龄段达到最大值，分别为33.14/10万，31.45/10万，34.99/10万。总体、男生和女生DALY率均在20~24岁年龄段达到最大值，分别为57.26/10万，53.80/10万，61.06/10万。
时期效应显示，以2002—2006年为参照(RR=1)，总体、女生的发病风险和DALY风险均呈现先下降后上升再下降的趋势，男生发病风险和DALY风险则呈下降趋势。总体、男生和女生发病风险及DALY风险均在2017—2021年达到最低，发病风险RR值分别为0.99(95%CI=0.97~1.00)，0.98(95%CI=0.96~1.00)，0.99(95%CI=0.97~1.01)；DALY风险RR值分别为0.98(95%CI=0.97~0.99)，0.98(95%CI=0.97~0.99)，0.99(95%CI=0.97~1.01)(P值均 < 0.05)。女生发病风险和DALY风险在1992—2002年均小于男生，在2002—2021年均大于男生。见图2。
队列效应显示，以1985—1989年出生队列为参照(RR=1)，总体、男生和女生的发病风险及DALY风险在1970—1974年到1985—1989年出生队列呈先上升后下降再上升的趋势，从1985—1989年到2005—2009年出生队列呈先下降后上升趋势，均在2000—2004年出生队列达到最低点，发病风险RR值分别为0.86(95%CI=0.84~0.87)，0.87(95%CI=0.85~0.88)，0.85(95%CI=0.83~0.86)；DALY风险RR值分别为0.86(95%CI=0.84~0.87)，0.87(95%CI=0.85~0.89)，0.84(95%CI=0.83~0.86)。见图2。
2.3　中国10~24岁青少年双相障碍标化发病率和标化DALY率预测
2022—2031年，中国10~24岁青少年双相障碍标化发病率和标化DALY率预计均呈上涨趋势。到2031年，总体标化发病率和标化DALY率分别涨至24.10/10万和34.90/10万，男生标化发病率和标化DALY率分别涨至23.00/10万和33.60/10万，女生标化发病率和标化DALY率分别涨至25.90/10万和37.20/10万。见图3。
3　讨论
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1990—2021年中国10~24岁青少年双相障碍标化发病率年均增长0.03%，双相障碍标化发病率较低，微小的增长也能反映出巨大的变化。遗传是双相障碍的首要病因，双相障碍遗传度可达80%[23]，增加了双相障碍的防控难度。城市化和空气污染与青少年双相障碍的发生有密切的关系[24]，1990—2021年中国正经历高速城市化和工业化，社会的变迁及生态环境的变化可能会对青少年精神健康造成影响。此外，青少年双相障碍的诊断水平在过去三十几年中不断提升，确诊人数不断增加，使标化发病率有所上升。进入21世纪，国家逐渐重视双相障碍在内的青少年精神障碍问题，《中小学心理健康教育指导纲要》《关于加强心理健康服务的指导意见》和《健康中国行动——儿童青少年心理健康行动方案(2019—2022年)》等一系列政策都强调对青少年心理健康的关注和干预，避免青少年双相障碍等精神障碍的出现和恶化[25-27]。临床防治方面，2007年《双相障碍防治指南》(第一版)为双相障碍的诊断防治提出了具体的标准和方案[28]，2020年《精神障碍诊疗规范》细化青少年双相障碍的诊疗方案[29]，极大促进了青少年双相障碍疾病负担的下降。1990—2021年中国10~24岁女生双相障碍的标化发病率和标化DALY率均高于男生，提示应对女性群体给予重点关注。雌激素水平波动、月经失调和性早熟均被证实是双相障碍的风险因素[30-31]，而这些问题在女生中较为常见。此外，相较男生，女生更易受成绩波动、家庭变故等负面事件的影响，也更易遭受校园欺凌，女生还面临“重男轻女”传统观念和现代社会性别平等的认知冲突，这些因素都会增加女生双相障碍的风险[32-34]。因此，需开展女性生理卫生教育，加强对女生的精神健康关注，促进青少年整体精神健康水平的提升。
本研究揭示15~19岁年龄组双相障碍发病率居3个年龄组之首。15~19岁正值中学时期，升学压力与青春期的身心变化，使这一年龄段面临较大的精神障碍风险[35]。与发病率不同，DALY率在20~24岁达到最高。青少年双相障碍患者常因延误诊断和延迟治疗导致临床状况恶化[36]，还常因接受不全面的治疗方案导致治疗效果较差[37]，这一系列原因提高了DALY率。时期效应显示，男生双相障碍发病及DALY风险总体呈下降趋势，而女生则经历先下降后上升再下降的波动。1992—2001年间，男、女生风险的下降可能与中国经济快速发展相关，良好的经济基础有助于降低发病风险并改善预后[38]。队列效应显示，1970—1989年出生队列的男女双相障碍发病与DALY风险呈波动上升趋势，该时期中国精神卫生服务不足且医保覆盖有限[39]，青少年双相障碍患者难以受到有效治疗，导致风险上升。1985—2004年出生队列则受益于经济繁荣、医疗基础设施完善及医保普及，双相障碍相关风险持续下降。2005—2009年出生的人群在青少年时期面临新型冠状病毒感染疫情的影响，隔离措施不仅加剧青少年精神障碍风险[40]，还扰乱了治疗进程；并且感染新型冠状病毒也可能诱发双相障碍[41]，导致该队列的DALY风险增加。
预测分析表明，2022—2031年间，中国10~24岁青少年双相障碍标化发病率与标化DALY率均将上升。针对未来较为严峻的青少年双相障碍防控压力，一是继续加强“双减”政策力度，减轻青少年学习压力，切实执行《全面加强和改进新时代学生心理健康工作专项行动计划(2023—2025年)》等政策[42]，加强对青少年心理问题的早期干预和治疗；二是拓宽治疗渠道，将社会心理疗法等引入治疗过程，增强青少年双相障碍患者治疗效果，降低疾病负担。
本研究尚存在一定的局限性：(1)研究的数据来自GBD公布的2021数据库，缺少对中国省市细分的数据；(2)GBD数据库中大部分数据依据模型得出，并非原始数据，尽管GBD采用标准化工具来提高准确性，但仍会存在部分偏差。
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  • 国家自然科学基金项目(82101602)
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doi: 10.16835/j.cnki.1000-9817.2025041
  • 接收时间：2024-10-22
  • 首发时间：2026-11-06
  • 出版时间：2025-02-25
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  • 收稿日期：2024-10-22
  • 修回日期：2024-11-28
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国家自然科学基金项目(82101602)
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    南京中医药大学卫生经济管理学院，江苏 210023

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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