Disability and depression among high utilizers of health care. A longitudinal analysis.
Disability and depression among high utilizers of health care. A longitudinal analysis.
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DOI：
10.1001/archpsyc.1992.01820020011002
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发表时间：
1992-02
影响因子：
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通讯作者：
M. Korff;Johan Ormel;Wayne Katon;E. Lin
中科院分区：
文献类型：
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作者：
M. Korff;Johan Ormel;Wayne Katon;E. Lin
我们评估了在高度利用医疗保健的抑郁症内科患者中，抑郁症的改善和未改善是否与功能性残疾病程的差异有关。在基线、6个月和12个月时，对健康维护组织(N=145)的参与者进行抑郁和残疾评估，这些参与者在非卧床医疗服务使用者中排名前十，超过健康维护组织人群抑郁症标准的第70%。抑郁症的改善被定义为在两次随访中平均至少减少三分之一的抑郁症状。在12个月的随访中，重度抑郁症患者的残疾天数减少了36%(每年79天到每年51天)，残疾得分减少了45%。中度抑郁症患者的残疾天数减少了72%(每年62天到每年18天)，残疾得分减少了40%。相比之下，重度抑郁症患者在基线时每年报告的残疾天数为134天，而中度抑郁症患者在基线时报告的残疾天数为77天。在1年的随访期内，没有一组抑郁症患者的残疾天数或残疾评分有改善。高卫生保健利用率和严重未改善的抑郁症更有可能患上当前的严重抑郁症和失业。改善的(相对于没有改善的)抑郁与身体疾病的严重程度和结婚率的边缘差异有关。我们得出结论，随着时间的推移，抑郁症和残疾的变化是同步的。然而，抑郁和残疾与残疾的变化可能是同步的，因为抑郁和残疾都受其他因素的控制，这些因素影响着抑郁的慢性化(如慢性病或人格障碍)。抑郁症和残疾的同步变化的发现为抑郁症和残疾内科患者中抑郁症治疗的随机对照试验提供了理论基础，以确定精神干预是否可以改善这类患者的功能状态。需要这样的研究来确定抑郁症抵消和功能障碍减少之间是否存在因果关系。
We evaluated, among depressed medical patients who are high utilizers of health care, whether improved vs unimproved depression is associated with differences in the course of functional disability. At baseline, 6 months, and 12 months, depression and disability were assessed among a sample of enrollees in health maintenance organizations (N = 145) in the top decile of users of ambulatory health care who exceeded the 70th percentile of health maintenance organization population norms for depression. Improved depression was defined as a reduction of at least one third in depressive symptoms averaged across the two follow-up times. At the 12-month follow-up, persons with severe-improved depression experienced a 36% reduction in disability days (79 days per year to 51 days per year) and a 45% reduction in disability score. Persons with moderate-improved depression experienced a 72% reduction in disability days (62 days per year to 18 days per year) and a 40% reduction in disability score. In contrast, persons with severe-unimproved depression reported 134 disability days per year at baseline, while persons with moderate-unimproved depression reported 77 disability days per year at baseline. Neither group with unimproved depression showed improvement in either disability days or disability score during the 1-year follow-up period. High utilizers of health care with severe-unimproved depression were more likely to have current major depression and to be unemployed. Improved (relative to unimproved) depression was associated with borderline differences in the severity of physical disease and in the percent married. We conclude that depression and disability showed synchrony in change over time. However, depression and disability may show synchrony in change with disability because both depression and disability are controlled by some other factor that influences the chronicity of depression (eg, chronic disease or personality disorder). The finding of synchronous change of depression and disability provides a rationale for randomized controlled trials of depression treatments among depressed and disabled medical patients to determine whether psychiatric intervention might improve functional status in such patients. Such research is needed to determine whether there is a causal relationship between depression offset and reductions in functional disability.