Service utilization and social morbidity associated with depressive symptoms in the community.
Service utilization and social morbidity associated with depressive symptoms in the community.
复制标题
DOI：
10.1001/jama.1992.03480110054033
复制
发表时间：
1992-03
期刊：
影响因子：
--
通讯作者：
James A. Johnson;M. Weissman;G. Klerman
中科院分区：
文献类型：
--
作者：
James A. Johnson;M. Weissman;G. Klerman
目的：评估社区中与抑郁症状相关的服务利用情况和社会病态情况。使用一种流行病学指标——人群归因危险度进行评估。人群归因危险度是一种综合指标，既反映了患有某种疾病的个体的发病风险，也反映了该疾病在社区中的患病率。
设计：流行病学调查
参与者：在美国5个社区通过复杂随机抽样选取的流行病学责任区研究中的18571名成年人
结果测量指标：自杀企图、精神活性药物的使用、自我报告的身心健康状况、工作时间损失以及因情绪问题使用的综合医疗服务或急诊科
结果：重性抑郁症 - 心境恶劣障碍（终生患病率为6.1%）和抑郁症状（终生患病率为23.1%）与结果变量所衡量的服务利用增加和社会病态情况相关。然而，从人群角度来看，抑郁症状所带来的服务负担和损害与抑郁症或心境恶劣障碍的临床病症相当，甚至更多。这种同等的相关性是由于抑郁症状的患病率更高。与抑郁症状（而非疾病）相关的人群归因危险度百分比如下：使用急诊科（11.8%）或因情绪问题就医（21.5%）；使用镇静剂（14.6%）、安眠药（21.0%）或抗抑郁药（22.2%）；自我报告情绪健康状况为一般或较差（15.3%）；工作时间损失（17.8%）；自杀企图（25.0%）
结论：人群归因危险度的评估表明，医生实际上为更多有抑郁症状的人提供服务，而不是为那些被正式定义患有抑郁症的人。由于患病率高，亚临床抑郁症是一个临床和公共卫生问题。需要关注诊断和治疗问题。
OBJECTIVE To estimate service utilization and social morbidity in the community associated with depressive symptoms. Estimates were made using an epidemiologic measure, population attributable risk. Population attributable risk is a compound measure reflecting both the morbid risk to an individual with a disorder and the prevalence of the disorder in the community. DESIGN Epidemiologic survey. PARTICIPANTS Eighteen thousand five hundred seventy-one adults in the Epidemiologic Catchment Area Study interviewed from a complex random sample in five US communities. OUTCOME MEASURES Suicide attempts, use of psychoactive medications, self-reported physical and emotional health, time lost from work, and general medical services or use of emergency departments for emotional problems. RESULTS Major depression-dysthymia (lifetime prevalence, 6.1%) and depressive symptoms (lifetime prevalence, 23.1%) were associated with increased service utilization and social morbidity as measured by the outcome variables. On a population basis, however, as much or more service burden and impairment was associated with depressive symptoms as with the clinical conditions of depression or dysthymia. The equal association results from the greater prevalence of depressive symptoms. Population attributable risk percentages associated with depressive symptoms (not disorder) were as follows: emergency department use (11.8%) or medical consultations for emotional problems (21.5%); use of tranquilizers (14.6%), sleeping pills (21.0%), or antidepressants (22.2%); fair or poor self-reported emotional health (15.3%); days lost from work (17.8%); and suicide attempts (25.0%). CONCLUSIONS Estimates of population attributable risk indicated that physicians actually provided services to more persons with depressive symptoms than to persons with formally defined conditions of depressive disorders. Subclinical depression, as a consequence of high prevalence, is a clinical and public health problem. Attention to diagnostic and treatment issues is indicated.