Treatment of Adult Depression in the United States
Treatment of Adult Depression in the United States
复制标题
DOI：
10.1001/jamainternmed.2016.5057
复制
发表时间：
2016-10-01
影响因子：
39
通讯作者：
Marcus, Steven C.
中科院分区：
文献类型：
--
作者：
Olfson, Mark;Blanco, Carlos;Marcus, Steven C.
重要性尽管最近在美国增加了抗抑郁药的使用，但人们仍然担心许多患有抑郁症的成年人没有接受治疗，而其他人接受的治疗与他们的疾病严重程度不匹配。和抑郁症治疗数据来自2012年和2013年18岁或以上参与者对美国家庭医疗支出小组调查的46417份回复。主要结局和指标筛查阳性抑郁症成年人的年龄（患者健康问卷-2分> 3）和社会人口学特征对筛查阳性抑郁症几率的影响的校正比值比（AOR）;筛查阳性抑郁症治疗的百分比和AOR;接受任何抑郁治疗的百分比和按严重心理困扰分层的AOR（Kessler 6量表评分>= 13）;按保健专业群体分列的接受抑郁症治疗的百分比（精神科医生、其他医疗保健专业人员和一般医疗提供者）;抑郁症治疗的类型（抗抑郁药，心理治疗，和两者）所有分层的痛苦水平。结果约8.4%（95% CI，7.9 - 8.8）的成年人筛查抑郁症阳性，其中28.7%接受任何抑郁症治疗。相反，在所有接受抑郁症治疗的成年人中，29.9%的人患有筛查阳性抑郁症，21.8%的人患有严重的心理困扰。与接受抑郁症治疗的不太严重的心理困扰的成年人相比，（33.4% vs 17.3%，P <.001）或其他心理健康专家（16.2%对9.6%，P <.001），并且不太可能只接受一般医疗专业人员的抑郁症治疗（59.0%对74.4%，P <.001）。他们也更有可能接受心理治疗（32.5%比20.6%，P <.001），虽然不是抗抑郁药物（81.1%比88.6%，P <.001）。结论和相关性大多数美国成年人谁屏幕上抑郁症阳性没有接受治疗抑郁症，而大多数谁是治疗没有屏幕上的阳性。鉴于这些发现，重要的是要加强努力，使抑郁症护理与每个患者的临床需求保持一致。
IMPORTANCE Despite recent increased use of antidepressants in the United States, concerns persist that many adults with depression do not receive treatment, whereas others receive treatments that do not match their level of illness severity.OBJECTIVE To characterize the treatment of adult depression in the United States.DESIGN, SETTING, AND PARTICIPANTS Analysis of screen-positive depression, psychological distress, and depression treatment data from 46 417 responses to the Medical Expenditure Panel Surveys taken in US households by participants aged 18 years or older in 2012 and 2013.MAIN OUTCOME AND MEASURES Percentages of adults with screen-positive depression (Patient Health Questionnaire-2 score of > 3) and adjusted odds ratios (AORs) of the effects of sociodemographic characteristics on odds of screen-positive depression; percentages with treatment for screen-positive depression and AORs; percentages with any treatment of depression and AORs stratified by presence of serious psychological distress (Kessler 6 scale score of >= 13); and percentages with depression treatment by health care professional group (psychiatrists, other health care professionals, and general medical providers); and type of depression treatment (antidepressants, psychotherapy, and both) all stratified by distress level.RESULTS Approximately 8.4%(95% CI, 7.9-8.8) of adults screened positive for depression, of which 28.7% received any depression treatment. Conversely, among all adults treated for depression, 29.9% had screen-positive depression and 21.8% had serious psychological distress. Adults with serious compared with less serious psychological distress who were treated for depression were more likely to receive care from psychiatrists (33.4% vs 17.3%, P < .001) or other mental health specialists (16.2% vs 9.6%, P < .001), and less likely to receive depression care exclusively from general medical professionals (59.0% vs 74.4%, P < .001). They were also more likely to receive psychotherapy (32.5% vs 20.6%, P < .001), though not antidepressant medications (81.1% vs 88.6%, P < .001).CONCLUSIONS AND RELEVANCE Most US adults who screen positive for depression did not receive treatment for depression, whereas most who were treated did not screen positive. In light of these findings, it is important to strengthen efforts to align depression care with each patient's clinical needs.