Correlates of late-life major depression: A comparison of urban and rural primary care patients
Correlates of late-life major depression: A comparison of urban and rural primary care patients
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DOI：
10.1097/01.jgp.0000224732.74767.ad
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发表时间：
2007-01-01
影响因子：
7.2
通讯作者：
Delavan, Rachel L.
中科院分区：
文献类型：
--
作者：
Friedman, Bruce;Conwell, Yeates;Delavan, Rachel L.
目的：本研究的目的是确定农村和城市老年居民中与抑郁相关的因素是否存在差异。方法：研究设计为横断面观察法。研究对象包括926名医疗保险初级保健患者(650名城市患者和276名农村患者)，他们年龄在65岁以上，认知正常，并参加了随机、对照的医疗保险演示。通过迷你国际神经精神病学访谈确定了重度抑郁症。Logistic回归模型估计包括一个城乡指标变量，额外的自变量，以及城乡指标和自变量之间的交互作用项，这些都是显著的ATP；0.10。结果：共有8.3%的农村患者和14.8%的城市患者被确定为重度抑郁症。报告0-1个亲密朋友(优势比：6.86；95%可信区间[CI]：2.18-21.58)、过去6个月就诊2次以上(优势比：4.00；95%可信区间：1.19-13.43)和更多的经济压力(优势比：1.50；95%可信区间：1.01-2.23)与农村患者患抑郁症的可能性显著高于城市患者。SF-36躯体成分总分与重度抑郁症之间存在曲线关系，城市患者的得分更高。当经济压力较小时，农村患者发生严重抑郁症的概率较低，当压力中等时，农村患者和城市患者的预测概率大致相同，而当压力较大时，农村患者发生严重抑郁的概率较高。结论：农村地区的临床医生应该警惕亲密朋友很少、最近去过几次急诊室的患者以及经济紧张的患者中的重度抑郁症。
Objective: The objective of this study was to determine whether factors associated with depression differ between elderly residents of rural and urban areas. Methods: The research design was cross-sectional and observational. The study subjects consisted of 926 Medicare primary care patients (650 urban and 276 rural) who were age 65+ and cognitively intact and had enrolled in a randomized, controlled Medicare demonstration. Major depression was identified by the Mini International Neuropsychiatric Interview. A logistic regression model was estimated that included a rural-urban indicator variable, additional independent variables, and interaction terms between the rural-urban indicator and independent variables that were significant atp < 0.10. Results: A total of 8.3% of the rural and 14.8% of the urban patients were identified as having major depression. Reporting 0-1 close friends (odds ratio [OR]: 6.86; 95% confidence interval [CI]: 2.18-21.58), 2+ emergency room visits during the past 6 months (OR.: 4.00; 95% CI: 1.19-13.43), and more financial strain (OR: 1.50; 95% CI: 1.01-2.23) were associated with significantly higher likelihood of major depression among rural as compared with urban patients. The SF-36 Physical Component Summary score had a curvilinear relationship with major depression and was higher for urban patients. The predicted probability for major depression is lower for the rural patients when financial strain is low, about the same for rural and urban patients when strain is intermediate, and higher for rural patients when strain is high. Conclusions: Clinicians in rural areas should be vigilant for major depression among patients with very few close friends, several recent emergency department visits, and financial strain.