Combined medical and psychological symptoms: impact on disability and health care utilization of patients with arthritis.
Combined medical and psychological symptoms: impact on disability and health care utilization of patients with arthritis.
复制标题
综合医学和心理症状：对关节炎患者残疾和医疗保健利用的影响。
DOI：
10.1097/00005650-199807000-00013
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发表时间：
1998
期刊：
影响因子：
3
通讯作者：
Walkup,J
中科院分区：
文献类型：
--
作者：
Vali,FM;Walkup,J
目的：许多报告表明，患有慢性疾病和抑郁症状的患者比单独患病的患者有更多的残疾，这可能会影响就诊。研究表明，输送系统对这些综合病症的适应能力不均衡，非精神科医生常常无法识别或治疗这些症状。为了满足这一需求，本研究旨在提供有关综合病症的进一步信息，并报告关节炎疾病症状、抑郁症和残疾之间的关系。方法。数据来自一系列全州范围的调查，评估了社会心理因素对风湿病专家护理下的 277 名患者的社区样本的病程和治疗的影响。我们开发了一个多变量模型来评估这些相互关系，使用症状严重程度、抑郁 (CESD)、残疾（日常生活活动、限制性活动天数、卧床天数）、服务利用以及一些个人和健康变量等指标。结果。即使从 CESD 中删除躯体项目以降低由于身体疾病导致的通货膨胀风险，证据也发现抑郁症对一项残疾指标（即活动天数）的附加影响。 限制性活动。患有合并症的患者也是服务利用率较高的群体。很少有患者报告在处理情绪问题时得到帮助，这表明存在大量未满足的需求。结论。非精神科医生需要了解慢性病患者的心理健康状况。尽管药物使用与抑郁症之间的关联表明人们对治疗抑郁症的必要性有所认识，特别是对于身体受损的患者，但可能需要向有需要的人提供心理和社会心理支持。
Objectives.Many reports indicate that patients with combined chronic illness and depressive symptomatology have more disability than those with illness alone, which may influence physician visits. Studies suggest that these combined conditions are unevenly accommodated by the delivery system and nonpsychiatric physicians often fail to recognize or treat these symptoms. To address this need, this study aimed to provide further information on combined conditions and report on relations found among arthritis disease symptoms, depression, and disability.Methods.The data was derived from a series of statewide surveys assessing the influence of psychosocial factors on disease course and treatment in a community sample of 277 patients under the care of a rheumatologist. A multivariate model was developed to assess these interrelationships, using measures of symptom severity, depression (CESD), disability (activities of daily living, days of restrictive activities, days in bed), service utilizations, and a few personal and health variables.Results.Even after removing somatic items from the CESD to reduce the risk of inflation due to physical disease, evidence was found for additive impact of depression on one measure of disability, days of restrictive activities. Patients with comorbid conditions also were a high-service utilization group. Very few patients reported receiving help in dealing with emotional problems, suggesting presence of substantial unmet need.Conclusions.Nonpsychiatric physicians need to be aware of the mental health status of chronically ill patients. Although the association between medication use and depression suggests some awareness of the need to treat depression, especially in physically compromised patients, there may be some need to dispense psychological and psychosocial support to those in need.