The clinical significance of subsyndromal depression in older primary care patients
The clinical significance of subsyndromal depression in older primary care patients
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DOI：
10.1097/01.jgp.0000235763.50230.83
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发表时间：
2007-03-01
影响因子：
7.2
通讯作者：
Caine, Eric D.
中科院分区：
文献类型：
--
作者：
Lyness, Jeffrey M.;Kim, JaeHyun;Caine, Eric D.
目的：许多老年人的抑郁症状不符合标准诊断标准。作者试图检查老年初级保健患者与“亚综合征抑郁症”（SSD）的临床相关性，假设SSD受试者比非抑郁症患者有更大的症状和功能障碍，但不像重度或轻度抑郁症患者那样严重，并探索在先前发表的工作中使用的三种不同SSD定义所捕获的受试者的特征。方法：作者进行了一项横断面病例比较研究，纳入了662例年龄≥ 65岁的初级保健患者。结果是精神病理学，医疗疾病负担和功能状态的有效措施。结果：所有三个SSD组捕获的患者比非抑郁组有更大的症状和功能障碍。SSD受试者在某些指标上与轻度或重度抑郁症受试者一样患病（例如，医疗负担）。每个SSD组定义都捕获了该组特有的一些主题。结论：亚综合征抑郁症是常见的，并与临床重要的症状或损害。仅依赖《精神障碍诊断与统计手册》第四版对重度或轻度抑郁症的定义，忽略了相当一部分具有临床显著抑郁症状的老年人。需要进行纵向研究，以帮助临床医生确定那些最有可能出现不良结局的患者，而测试机制模型的研究人员应该包括SSD患者，以确定他们是否与更严重的情绪障碍有共同的发病基础。
Objective: Many seniors experience depressive symptoms not meeting standard diagnostic criteria. The authors sought to examine the clinical correlates of older primary care patients with "subsyndromal depression" (SSD), hypothesizing that SSD subjects have greater symptoms and functional impairment than nondepressed patients, but not as severe as those with major or minor depression, and to explore the characteristics of subjects captured by three different definitions of SSD used in prior published work. Methods: The authors conducted a cross-sectional case comparison study that enrolled 662 primary care patients age >= 65 years. Outcomes were validated measures of psychopathology, medical illness burden, and functional status. Results: All three SSD groups captured patients with greater symptoms and functional impairment than the nondepressed group. SSD subjects were as ill as those with minor or major depression on some measures (e.g., medical burden). Each SSD group definition captured some subjects unique to that group. Conclusions: Sub-syndromal depression is common and associated with symptoms or impairments of clinical importance. Sole reliance on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition definitions of major or minor depression omits a substantial proportion of seniors with clinically significant depressive symptoms. Longitudinal study is needed to help clinicians identify those at greatest risk for poor outcomes, while researchers testing mechanistic models should include patients with SSD to determine whether they share pathogenetic underpinnings with more severe mood disorders.