MEDICAL COMORBIDITY OF MAJOR DEPRESSIVE DISORDER IN A PRIMARY MEDICAL-PRACTICE
MEDICAL COMORBIDITY OF MAJOR DEPRESSIVE DISORDER IN A PRIMARY MEDICAL-PRACTICE
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DOI：
10.1001/archinte.150.11.2363
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发表时间：
1990-11-01
影响因子：
--
通讯作者：
ARENA, VC
中科院分区：
文献类型：
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作者：
COULEHAN, JL;SCHULBERG, HC;ARENA, VC
尽管有很多关于初级保健环境中抑郁症和医疗合并症之间关系的猜测，但很少有研究者从经验上研究这个问题。采用两阶段筛选程序，我们评估了618名18至64岁的学术全科医学诊所患者。41名患者（6.6%）患有重度抑郁障碍（MDD）的当前发作。我们将这一组与随机抽取的20%的非抑郁症患者进行比较。虽然重度抑郁症患者较年轻（平均年龄，41.1 vs 47.2岁），但他们被杜克大学疾病严重程度量表评估为患有更严重的内科疾病。重度抑郁症患者比非抑郁症患者更容易患恶性肿瘤和“不明确的状况”。被医生正确诊断为重度抑郁症的18名患者（44%）比那些临床未发现抑郁症的患者有更轻的医学疾病。预测MDD群体成员的逻辑回归模型包括女性、年龄较小、杜克大学疾病严重程度量表得分较高以及更频繁的不活跃的不明确诊断。这些发现与断言一致：重度抑郁症患者比非抑郁症患者有更多的身体疾病和/或由重度抑郁症引起的躯体症状和残疾增加了身体疾病的负担。
Despite much speculation about the relationship between depression and medical comorbidity in primary care settings, few investigators have examined this issue empirically. Using a two-stage screening procedure, we assessed 618 patients aged 18 to 64 years in an academic general medicine clinic. Forty-one patients (6.6%) suffered from a current episode of major depressive disorder (MDD). We compared this group with a 20% random sample of nondepressed patients. While patients with MDD were younger (mean age, 41.1 vs 47.2 years), they were assessed by the Duke University Severity of Illness Scale as having more severe medical illness. Patients with MDD were more likely to have malignant tumors and "ill-defined conditions" than nondepressed patients. The 18 patients with MDD (44%) who were correctly diagnosed by their physicians had less severe medical illness than those whose depression was clinically undetected. A logistic regression model predicting MDD group membership included female gender, younger age, higher Duke University Severity of Illness Scale score, and more frequent inactive ill-defined diagnoses. These findings are consistent with assertions: patients with MDD have more physical illness than nondepressed patients and/or somatic symptoms and disability caused by MDD add to the burden of physical illness.