The course of untreated anxiety and depression, and determinants of poor one-year outcome: a one-year cohort study.
The course of untreated anxiety and depression, and determinants of poor one-year outcome: a one-year cohort study.
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DOI：
10.1186/1471-244x-10-86
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发表时间：
2010-10-20
期刊：
影响因子：
4.4
通讯作者：
Penninx BW
中科院分区：
文献类型：
--
作者：
van Beljouw IM;Verhaak PF;Cuijpers P;van Marwijk HW;Penninx BW
对于有或没有自我感觉需要护理的患者，未经治疗的焦虑和抑郁的过程和结果知之甚少。本研究的目的是检查未经治疗的焦虑和抑郁的一年病程，并确定不良结果的预测因素。使用来自荷兰抑郁和焦虑研究 (NESDA) 的 594 名初级保健患者的基线和一年随访数据（由综合访谈诊断工具 (CIDI) 建立）。通过感知护理需求问卷 (PNCQ) 评估护理的接受情况和需求。在抑郁症中，与没有自我感知的精神问题或治疗需要的未经治疗的患者相比，有感知的治疗需要的治疗和未治疗的患者在随访中表现出更快的症状下降，但症状更严重。较低的教育水平、较低的收入、失业、孤独、较少的社会支持、感知的护理需求、躯体疾病的数量、共病焦虑和抑郁症以及基线症状严重程度预示着焦虑和抑郁的结果较差。当同时考虑所有变量时，只有基线症状严重程度似乎可以预测焦虑的较差结果。在抑郁症中，更多的孤独感以及共病的焦虑和抑郁症也预示着结果会更差。在临床实践中，应特别注意探索可能的高危人群（如社会经济地位低、社会支持度低）的护理需求，并支持他们做出是否寻求治疗的知情决定。
Little is known about the course and outcome of untreated anxiety and depression in patients with and without a self-perceived need for care. The aim of the present study was to examine the one-year course of untreated anxiety and depression, and to determine predictors of a poor outcome. Baseline and one-year follow-up data were used of 594 primary care patients with current anxiety or depressive disorders at baseline (established by the Composite Interview Diagnostic Instrument (CIDI)), from the Netherlands Study of Depression and Anxiety (NESDA). Receipt of and need for care were assessed by the Perceived Need for Care Questionnaire (PNCQ). In depression, treated and untreated patients with a perceived treatment need showed more rapid symptom decline but greater symptom severity at follow-up than untreated patients without a self-perceived mental problem or treatment need. A lower education level, lower income, unemployment, loneliness, less social support, perceived need for care, number of somatic disorders, a comorbid anxiety and depressive disorder and symptom severity at baseline predicted a poorer outcome in both anxiety and depression. When all variables were considered at the same time, only baseline symptom severity appeared to predict a poorer outcome in anxiety. In depression, a poorer outcome was also predicted by more loneliness and a comorbid anxiety and depressive disorder. In clinical practice, special attention should be paid to exploring the need for care among possible risk groups (e.g. low social economic status, low social support), and support them in making an informed decision on whether or not to seek treatment.