Recognition of depression by primary care clinicians in rural Ethiopia
Recognition of depression by primary care clinicians in rural Ethiopia
复制标题
DOI：
10.1186/s12875-017-0628-y
复制
发表时间：
2017-04-21
影响因子：
2.9
通讯作者：
Hanlon, Charlotte
中科院分区：
文献类型：
--
作者：
Fekadu, Abebaw;Medhin, Girmay;Hanlon, Charlotte
背景：抑郁症是一种常见的健康状况，影响着多达三分之一的初级保健患者，而初级保健机构为抑郁症患者提供了大部分护理。对抑郁症的充分认识是获得有效护理的关键一步，特别是在低收入国家。作为改善精神卫生保健计划 (PRIME) 的一部分，该计划支持在初级保健中实施综合精神卫生保健，我们在服务培训之前评估了埃塞俄比亚农村初级保健工作的临床医生对抑郁症的认识程度。我们假设抑郁症的检出率将低于 10%，并且检出率将受到性别、教育程度和抑郁症严重程度的影响。方法：在为超过 160,000 人提供服务的八个卫生中心进行横断面调查。经验证的 9 项患者健康问卷 (PHQ-9) 版本被用作可能抑郁症的指标。此外，初级保健临床医生填写了临床医生接触表。参与者是年满 18 岁及以上的连续初级保健参与者。结果：共有 1014 名参与者接受了评估。初级保健临床医生诊断 13 名参加者 (1.3%) 患有抑郁症。 PHQ9 抑郁症患病率（截止分数为 10 分）为 11.5% (n = 117)，其中 5% (n = 6/117) 已被初级保健临床医生诊断为抑郁症。 PHQ 得分较高且有自杀倾向的参与者更有可能被临床医生诊断为抑郁症。女性（n = 9/13）和受教育程度较高的参与者更有可能被诊断为抑郁症，尽管不显着。所有被临床医生诊断为抑郁症的病例都出现了心理症状。结论：虽然没有基于金标准诊断，但超过98%的PHQ-9抑郁症病例未被发现。未能认识到抑郁症可能会对低收入国家扩大精神卫生保健造成严重威胁。解决这一威胁应该是当务之急，需要更好地了解抑郁症的性质及其在农村低收入初级保健机构中的表现。
Background: Depression is a common health condition affecting up to a third of patients attending primary care, where most of the care for people with depression is provided. Adequate recognition of depression is the critical step in the path to effective care, particularly in low income countries. As part of the Programme for Improving Mental healthcare (PRIME), a project supporting the implementation of integrated mental healthcare in primary care, we evaluated the level of recognition of depression by clinicians working in primary care in rural Ethiopia prior to in service training. We hypothesised that the detection rate of depression will be under 10% and that detection would be affected by gender, education and severity of depression.Methods: Cross-sectional survey in eight health centres serving a population of over 160,000 people. A validated version of the 9-item patient health questionnaire (PHQ-9) was administered as an indicator of probable depression. In addition, primary care clinicians completed a clinician encounter form. Participants were consecutive primary care attendees aged 18 years and above.Results: A total of 1014 participants were assessed. Primary care clinicians diagnosed 13 attendees (1.3%) with depression. The PHQ9 prevalence of depression at a cut-off score of ten was 11.5% (n = 117), of whom 5% (n = 6/117) had received a diagnosis of depression by primary care clinicians. Attendees with higher PHQ scores and suicidality were significantly more likely to receive a diagnosis of depression by clinicians. Women (n = 9/13) and participants with higher educational attainment were more likely to be diagnosed with depression, albeit non-significantly. All cases diagnosed with depression by the clinicians had presented with psychological symptoms.Conclusion: Although not based on a gold standard diagnosis, over 98% of cases with PHQ-9 depression were undetected. Failure of recognition of depression may pose a serious threat to the scale up of mental healthcare in low income countries. Addressing this threat should be an urgent priority, and requires a better understanding of the nature of depression and its presentation in rural low-income primary care settings.