Differences in symptom scores and health outcomes in premenstrual syndrome
Differences in symptom scores and health outcomes in premenstrual syndrome
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DOI：
10.1089/jwh.2006.0230
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发表时间：
2007-10-01
影响因子：
3.5
通讯作者：
Yonkers, Kimberly A.
中科院分区：
文献类型：
--
作者：
Borenstein, Jeff E.;Dean, Bonnie B.;Yonkers, Kimberly A.
背景资料：在经前综合征（PMS）的研究中，对治疗的显著反应通常被定义为症状评分减少50%，但缺乏对这一定义的经验支持。我们比较了妇女的医疗保健利用率，并没有PMS根据每日记录的问题的严重程度（DRSP）的分数，以确定在疾病的负担差异相关的经前症状的症状变化的程度。方法：参与者是18-45岁的妇女参加了医疗组在南加州。受访者在基线时完成了医学结局研究简表-36（SF-36），每天完成DRSP症状和职业生产力项目。黄体期DRSP评分在两个连续周期内取平均值。使用先前发表的有效算法，将受访者分为轻度/无和中度/重度PMS或经前焦虑障碍（PMDD）。根据研究入组前2年的医疗索赔数据估计医疗费用。与中度/重度PMS/PMDD患者（n = 117）相比，轻度/无PMS/PMDD患者（n = 271）的DRSP评分低43（29.7和52.4，p < 0.05），SF-36精神成分汇总较高（49.9和40.5，p < 0.0001）和物理成分总结（52.6和50.8，p = 0.04）得分，每月工作日减少，生产率降低（13.3和22.0，p < 0.0001），由于健康原因错过的工作日减少（1.2和2.7，p = 0.001）。中度/重度经前综合征/经前抑郁症的女性就诊次数>10次（OR = 1.80，95%CI 1.01，3.22）和累积医疗费用> 500美元（OR = 1.9，95%CI 1.2，3.0）的几率更大。结论：经前症状评分与经后症状评分的43%差异与医疗负担的显著差异相关。这些数据支持在PMS/PMDD治疗试验中使用症状评分降低50%作为临床相关改善，尽管较小的差异也可能有意义。
Background: In studies of premenstrual syndrome (PMS), a significant response to treatment is commonly defined as a 50% reduction in symptom scores, but empirical support for this definition is lacking. We compared healthcare utilization in women with and without PMS according to the Daily Record of Severity of Problems (DRSP) scores in order to determine the degree of symptomatic variation in premenstrual symptoms associated with differences in the burden of illness.Methods: Participants were women aged 18-45 years enrolled in a medical group in southern California. Respondents completed the Medical Outcomes Study Short Form-36 (SF-36) at baseline and the DRSP symptom and occupational productivity items daily. Luteal phase DRSP scores were averaged over two consecutive cycles. Respondents were categorized as having mild/ no and moderate/severe PMS or premenstrual dysphoric disorder (PMDD) using a previously published, validated algorithm. Medical costs were estimated from medical claims data over the 2 years prior to study entry.Results: Compared with women with moderate/severe PMS/PMDD (n = 117), those with mild/no PMS/PMDD (n = 271) had 43% lower DRSP scores (29.7 and 52.4, p < 0.05), higher SF-36 mental component summary (49.9 and 40.5, p < 0.0001) and physical component summary (52.6 and 50.8, p = 0.04) scores, and fewer workdays per month with reduced productivity (13.3 and 22.0, p < 0.0001) and workdays missed due to health reasons (1.2 and 2.7, p = 0.001). Women with moderate/severe PMS/PMDD had greater odds of having >10 office visits (OR = 1.80, 95% CI 1.01, 3.22) and of accumulating >$ 500 in medical charges (OR = 1.9, 95% CI 1.2, 3.0).Conclusions: A 43% difference in premenstrual vs. postmenstrual symptom scores is associated with a significant difference in healthcare burden. These data support the use of a 50% reduction in symptom ratings as a clinically relevant improvement in PMS/PMDD treatment trials, although smaller differences may also be meaningful.