Prevalence, burden, and treatment of insomnia in primary care.
Prevalence, burden, and treatment of insomnia in primary care.
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初级保健中失眠的患病率、负担和治疗。
DOI：
10.1176/ajp.154.10.1417
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发表时间：
1997
期刊：
影响因子：
--
通讯作者：
VonKorff,M
中科院分区：
文献类型：
--
作者：
Simon,GE;VonKorff,M
目的了解基层医疗患者失眠的患病率、负担及管理情况。方法采用12项一般健康问卷对职工型健康维护组织基层医疗门诊1962例18~65岁患者进行连续筛查。分层随机样本（N = 373）完成了面对面的诊断评估，包括综合国际诊断访谈、简短的自评残疾问卷（Brief Disability Questionnaire）和访谈者评定的社会残疾表。 3个月后完成电话跟踪调查。通过使用健康计划的自动数据系统来评估精神药物的使用、心理健康服务的使用以及直接医疗保健费用。结果大约 10% 的初级保健患者报告目前存在严重失眠（例如，几乎每晚至少需要 2 小时才能入睡）。目前的失眠与明显更大的功能障碍（根据简要残疾调查问卷和社会残疾表）、由于健康问题而导致残疾的天数增加以及一般医疗服务利用率更高有关。虽然失眠与抑郁症和慢性疾病有关，但对这些因素的调整仅部分解释了失眠与残疾和医疗保健利用的关联。目前失眠的患者中，28%接受过任何精神药物治疗； 14% 接受苯二氮卓类药物治疗，19% 接受抗抑郁药物治疗。结论初级保健患者的失眠与更大的功能障碍、生产力损失和过度医疗保健利用有关。
ObjectiveThe prevalence, burden, and management of insomnia among primary care patients were evaluated.MethodConsecutive patients aged 18 to 65 years in primary care clinics of a staff-model health maintenance organization (N= 1,962) were screened with the 12-item General Health Questionnaire. A stratified random sample (N= 373) completed face-to-face diagnostic assessments including the Composite International Diagnostic Interview, a brief self-rated disability questionnaire (Brief Disability Questionnaire), and the interviewer-rated Social Disability Schedule. A telephone follow-up survey was completed 3 months later. Use of psychotropic drugs, use of mental health services, and direct health care costs were assessed by using the health plan’s automated data systems.ResultsApproximately 10% of the primary care patients reported major current insomnia (eg, taking at least 2 hours to fall asleep nearly every night). Current insomnia was associated with significantly greater functional impairment (according to both Brief Disability Questionnaire and Social Disability Schedule), more days of disability due to health problems, and greater general medical service utilization. While insomnia was associated with depressive disorder and chronic medical illness, adjustment for these factors only partially accounted for the association of insomnia with disability and with health care utilization. Of the patients with current insomnia, 28% received any psychotropic drug; 14% received benzodiazepines and 19% received antidepressants.ConclusionsInsomnia among primary care patients is associated with greater functional impairment, lost productivity, and excess health care utilization.