Background: Studies from Western countries consistently report very high rates of comorbid Antisocial Personality Disorder (ASPD) among individuals with heroin addiction, but the reported proportion of Chinese individuals with heroin addiction who have co-morbid ASPD varies widely, possibly because Chinese clinicians do not consider personality issues when treating substance abuse problems.
Aim: Conduct a meta-analysis of studies that assessed the proportion of Chinese individuals with heroin dependence who have comorbid ASPD.
Methods: We searched for relevant studies in both Chinese databases (China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, Taiwan Electronic Periodical Services) and western databases (PubMed, EMBASE, and PsycInfo). Two authors independently retrieved the literature, identified studies that met pre-defined inclusion and exclusion criteria, assessed the quality of included studies, and extracted the data used in the analysis. Statistical analysis was performed using StatsDirect 3.0 and R software.
Results: The search yielded 15 eligible studies with a total of 3692 individuals with heroin dependence. Only 2 of the studies were rated as high-quality studies. All studies were conducted in rehabilitation centers or hospitals. The pooled lifetime prevalence of ASPD in these subjects was 30% (95%CI: 23%-38%), but the heterogeneity of results across studies was great (I(2) =95%, p<0.001). Men had a higher prevalence than women (44% vs. 21%), and injection heroin users had higher prevalence than those who smoked heroin (44% vs. 27%). Studies that were methodologically stronger had higher reported prevalence of ASPD among heroin dependent individuals.
Conclusions: There are substantial methodological problems in the available literature about ASPD in Chinese individuals receiving treatment for heroin dependence, but we estimate that about one-third of them meet criteria for ASPD. Further work is needed to increase clinicians' awareness of this issue; to compare the pathogenesis, treatment responsiveness and recidivism of those with and without ASPD; and to develop and test targeted interventions for this difficult-to-treat subgroup of individuals with heroin dependence.
背景: 西方国家的研究持续报道海洛因成瘾者共患反 社会人格障碍（Antisocial Personality Disorder，ASPD） 的比率很高，但中国海洛因成瘾者共患ASPD的报道比 率变异很大，可能是因为中国的临床医生在治疗物质 滥用问题时没有考虑人格问题。这份报告对评估中国 海洛因依赖患者共患ASPD比率的研究做了系统分析。
方法: 我们检索了中国数据库（中国知网，万方数据 知识服务平台，台湾电子期刊服务网）和西方数据库 （PubMed和EMBASE）的相关研究。两位作者独立检 索文献，确定符合预定纳入和排除标准的文献，评价 纳入研究的文献质量，并提取用于分析的数据。使用 StatsDirect 3.0进行统计分析。
结果: 检索到15项符合条件的研究，共有3692例海 洛因依赖患者。其中仅有2项高质量研究。所有的研 究都是在康复中心或医院进行的。 在这些患者中合 并ASPD终生患病率为30％（95％CI：23~38％）， 但这些研究结果的异质性很大（I2 =95%, p<0.001）。男性患者的患病率显著高于女性（44％比21％）， 注射吸毒患者的患病率显著高于烫吸的患者（44％比 27％）。研究方法较严谨的报道的海洛因依赖者ASPD 患病率较高。
结论: 虽然现有的有关中国接受治疗的海洛因依赖患 者共患ASPD的文献存在较大的方法学问题，但据我 们的分析，估计这些患者中大约有三分之一的人是符 合ASPD诊断标准的。进一步需要开展的工作是提高临 床医生对这一问题的认识，比较伴ASPD患者与不伴 ASPD患者的发病机制、治疗效果和复吸情况，制定出 适合这个治疗相对困难的海洛因依赖患者亚群的针对 性的干预措施并加以验证。
Keywords: Antisocial personality disorder; China; Heroin dependence; meta-analysis; prevalence.