Depression, anxiety, and somatoform disorders: Vague or distinct categories in primary care? Results from a large cross-sectional study
Depression, anxiety, and somatoform disorders: Vague or distinct categories in primary care? Results from a large cross-sectional study
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DOI：
10.1016/j.jpsychores.2009.04.013
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发表时间：
2009-09-01
影响因子：
4.7
通讯作者：
Loewe, Bernd
中科院分区：
文献类型：
--
作者：
Hanel, Gertraud;Henningsen, Peter;Loewe, Bernd
目的：抑郁、焦虑和躯体化是初级卫生保健中最常见的精神障碍。我们的主要目标是利用经常被忽视的全科医生 (GP) 的观点来调查这三种常见精神诊断的特征，以便在 DSM-V 和 ICD-11 中创建更合适的类别。方法：我们收集了来自德国 1751 名初级保健患者（参与率 = 77%）及其 32 名治疗全科医生的独立数据。患者填写了经过验证的抑郁症自我报告测量 (PHQ-9)、躯体症状严重程度 (PHQ-15) 和疾病焦虑 (Whiteley-7)，以及有关疾病应对和归因的问题。对全科医生的临床诊断和相关特征进行了评估。结果：与未诊断为精神障碍的参考组相比，被全科医生诊断为抑郁症、焦虑症和/或躯体形式障碍的患者年龄明显更大，受教育程度较低，且女性比例更高。他们看全科医生的频率更高，症状持续时间更长，并且更经常承受社会或经济压力。在全科医生诊断的精神障碍中，与参考组相比，抑郁症（OR = 4.4；95% CI = 2.6至7.5）以及躯体形式、抑郁和焦虑障碍的合并症（OR = 9.5；95% CI = 4.6至19.4）与参考组的损害程度最大相关。诊断为躯体/功能障碍的患者在所有维度上仅出现轻度受损（OR=2.0；95% CI=1.4 至 2.7）。对于医生将心理社会因素归因于疾病的原因和维持、困难的医患关系以及自我评估的精神障碍，也发现了类似的结果。结论：为了使 DSM-V 和 ICD-11 更适合初级保健，我们建议为 (1) 初级保健中常见的许多轻度精神综合症提供适当的诊断类别； (2) 躯体形式障碍、抑郁症和/或焦虑症之间的严重合并症，例如采用维度方法。 (C) 2009 Elsevier Inc. 保留所有权利。
Objective: Depression, anxiety, and somatization are the most frequently observed mental disorders in primary health care. Our main objective was to draw on the often neglected general practitioners' (GPs) perspective to investigate what characterizes these three common mental diagnoses with regard to creating more suitable categories in the DSM-V and ICD-11. Methods: We collected independent data from 1751 primary care patients (participation rate=77%) and their 32 treating GPs in Germany. Patients filled out validated patient self-report measures for depression (PHQ-9), somatic symptom severity (PHQ-15), and illness anxiety (Whiteley-7), and questions regarding coping and attribution of illness. GPs' clinical diagnoses and associated features were assessed. Results: Patients diagnosed by their GPs with depression, anxiety, and/or somatoforrn disorders were significantly older, less educated, and more often female than the reference group not diagnosed with a mental disorder. They had visited the GP more often, had a longer duration of symptoms, and were more often under social or financial stress. Among the mental disorders diagnosed by the GPs, depression (OR=4.4; 95% CI=2.6 to 7.5) and comorbidity of somatoform, depressive, and anxiety disorders (OR=9.5; 95% CI=4.6 to 19.4) were associated with the largest degrees of impairment compared to the reference group. Patients diagnosed as having a somatoforn/functional disorder only had mildly elevated impairment on all dimensions (OR=2.0; 95% CI=1.4 to 2.7). Similar results were found for the physicians' attribution of psychosocial factors for cause and maintenance of the disease, difficult patient-doctor relationship, and self-assessed mental disorder. Conclusion: In order to make the DSM-V and ICD-11 more suitable for primary care, we propose providing appropriate diagnostic categories for (1) the many mild forms of mental syndromes typically seen in primary care; and (2) the severe forms of comorbidity between somatoform, depressive, and/or anxiety disorder, e.g., with a dimensional approach. (C) 2009 Elsevier Inc. All rights reserved.