【作者】 卢静；

【导师】 李舜伟； 魏镜；

【作者基本信息】 中国协和医科大学 ， 临床医学， 2008， 博士

【摘要】 研究背景:抑郁/焦虑障碍目前已成为日益严重的公共卫生问题。近年来大量研究证实,抑郁障碍是一种高患病率、高复发率、高疾病负担及高自杀率的精神疾病。WHO报告的中国疾病负担分布情况也显示:抑郁症已成为我国疾病负担最大的第二号疾病。国外研究显示,躯体疾病患者心理障碍发病率明显高于普通人群,而且在较重躯体疾病基础上合并的抑郁症会严重影响躯体疾病的预后和转归。抑郁症是一种可以得到有效治疗的疾病,因此提高其诊治率是迫切需要解决的问题。研究发现,有相当一部分抑郁障碍的患者以躯体的各种不适为主诉,不少患有抑郁症的病人到综合医院非精神心理科就诊,向医生诉说的是躯体症状,而不是抑郁情绪,故其抑郁症常常被误诊或漏诊。因此,研究综合医院门诊病人中抑郁/焦虑障碍的现状及非精神科医师对抑郁/焦虑障碍的识别率和治疗率具有重要的现实意义和科研价值。研究目的:调查综合医院门诊就诊者抑郁和/或焦虑障碍的现状,以及描述综合医院门诊医师对抑郁和/或焦虑的识别率;调查综合医院各科(神经科、消化科、心血管和妇科)门诊就诊者中抑郁/焦虑障碍的检出率。研究方法:采用现况调查的方法,调查北京协和医院神经科、消化科、心内科及妇科门诊619名患者的心理健康和医生诊治情况,所有HADS评分(抑郁或焦虑)≥8的就诊者再用国际神经精神科简式访谈确定焦虑/抑郁障碍的诊断,由此计算检出率。研究结果:619例患者中,351例(56.7%,351/619)HADS表评分≥8分,281例(80.1%,281/351)进入精神科访谈,116例被诊断为抑郁/焦虑障碍。经过校正,抑郁的总体检出率为18.4%,焦虑的总体检出率为13.2%,抑郁/焦虑的总体检出率为23.6%,四个科室的抑郁/焦虑障碍检出率分别为:神经科34.0%,消化科18.8%,心内科13.5%,妇科27.4%。门诊医生的识别率为18.9%。研究结论:综合医院门诊患者具有较高的抑郁/焦虑障碍检出率.门诊医生的识别率不高,不能满足患者的治疗需求。更多还原

【Abstract】 Background: The depressive and/or anxiety disorders are becoming more serious problems of public health. The recent studies have proved that the depression has a high morbidity, recurrence, sickness distribution and suicide rate. The Chinese sickness distribution report by WHO also indicated that the depression has already become the second most serious disease in China. The international study showed that the mental disorder morbidity of somatopathic people was obviously higher than ordinary people. In addition, the somatopathy with a combination of depression could seriously impacted its prognosis. Major depression Disorder is a curable disease, but the problem of its diagnostic and treatment rate needs to be urgently improved. Many studies have shown that many depression disturbed people informed doctors about their various uncomfortable feelings of bodies and some just went to the non- psychiatric departments of general hospitals. As a result, many depression disturbed people were misdiagnosed and mistreated. Therefore, it’s important in both the practical application and the research field to make a study on the profile of depressive and/or anxiety disorders in outpatients of general hospitals and the recognition rate of the doctors in non-psychiatric departments.Objective: To describe the profile of depressive and/or anxiety disorders in outpatients of a general hospital. To describe the recognition rate of the doctors in non-psychiatric departments of a general hospital. And to describe the detection rate of depressive and/or anxiety disorders in outpatients in neurology, gastroenterology, cardiology and gynecology of a general hospital.Method: A hospital-based cross-sectional study was conducted in neurology, gastroenterology, cardiology and gynecology of a general hospital in 2007. 619 outpatients were recruited within one month. All of the subjects completed the self rated Hospital Anxiety and Depression (HAD) scale for screening, and the patients those HAD scores were 8 and above were interviewed by psychiatrists. Psychiatric diagnoses were made using the Mini International Neuropsychiatric Interview (MINI). Then we can calculate the detection rate of depressive and/or anxiety disorders.Result: 351 (56.7%, 351/619) outpatients had 8 or more in HAD screen, and 281 (80.1%, 281/351) of them were interviewed by psychiatrists. 116 subjects were diagnosed as depressive and/or anxiety disorders. These patients had more trouble in living, working and sociality. After adjusted, the detection rate of depressive disorders in all outpatients was 18.4%, the detection rate of anxiety disorders in all outpatients was 13.2%, the detection rate of depressive and/or anxiety disorders in all outpatients was 23.6%, and the detection rate of depressive and/or anxiety disorders in outpatients in neurology, gastroenterology, cardiology and gynecology were 34.0%, 18.8%, 13.5% and 27.4% respectively. Only 18.9% of those patients were recognized.Conclusion It is noticeable that high prevalence of depressive and/or anxiety disorders was found in outpatients of a general hospital, and that low percentage of recognization they obtained.更多还原