Depression is a risk factor for noncompliance with medical treatment -: Meta-analysis of the effects of anxiety and depression on patient adherence
Depression is a risk factor for noncompliance with medical treatment -: Meta-analysis of the effects of anxiety and depression on patient adherence
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DOI：
10.1001/archinte.160.14.2101
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发表时间：
2000-07-24
影响因子：
--
通讯作者：
Croghan, TW
中科院分区：
文献类型：
--
作者：
DiMatteo, MR;Lepper, HS;Croghan, TW
背景：抑郁症和焦虑症在内科患者中很常见，并且与健康状况下降以及医疗保健利用率增加有关。本文对内科患者的治疗不依从性与其焦虑和抑郁相关的研究进行了定量综述和综合。
方法：对1968年1月1日至1998年3月31日在MEDLINE和PsychLit上编目的患者依从性研究进行了审查，如果研究测量了患者的依从性以及抑郁或焦虑（样本量n>10）；涉及由非精神科医生向未因焦虑、抑郁或精神疾病接受治疗的患者推荐的医疗方案；并且测量了患者依从性与患者焦虑和/或抑郁之间的关系（或提供了计算该关系的数据），则将其纳入本综述。
结果：12篇关于抑郁的文章和13篇关于焦虑的文章符合纳入标准。焦虑与不依从之间的关联是多样的，其平均值较小且不显著。然而，抑郁与不依从之间的关系是显著且重要的，优势比为3.03（95%置信区间，1.96 - 4.89）。
结论：与非抑郁患者相比，抑郁患者不依从医疗建议的几率要高3倍。对未来研究的建议包括关注因果推断以及探索解释这些影响的机制。抑郁与医疗不依从之间强烈的共变证据表明，对于可能不遵循医疗建议的患者，将抑郁视为不良结果的风险因素是很重要的。
Background: Depression and anxiety are common in medical patients and are associated with diminished health status and increased health care utilization. This article presents a quantitative review and synthesis of studies correlating medical patients' treatment noncompliance with their anxiety and depression.Methods: Research on patient adherence catalogued on MEDLINE and PsychLit from January 1, 1968, through March 31, 1998, was examined, and studies were included in this review if they measured patient compliance and depression or anxiety (with n>10); involved a medical regimen recommended by a nonpsychiatrist physician to a patient not being treated for anxiety, depression, or a psychiatric illness; and measured the relationship between patient compliance and patient anxiety and/or depression (or provided data to calculate it).Results: Twelve articles about depression and 13 about anxiety met the inclusion criteria. The associa- tions between anxiety and noncompliance were variable, and their averages were small and nonsignificant. The relationship between depression and noncompliance, however, was substantial and significant, with an odds ratio of 3.03 (95% confidence interval, 1.96-4.89).Conclusions: Compared with nondepressed patients, the odds are 3 times greater that depressed patients will be noncompliant with medical treatment recommendations. Recommendations for future research include attention to causal inferences and exploration of mechanisms to explain the effects. Evidence of strong covariation of depression and medical noncompliance suggests the importance of recognizing depression as a risk factor for poor outcomes among patients who might not be adhering to medical advice.