Depression symptomatology and diagnosis: discordance between patients and physicians in primary care settings.
Depression symptomatology and diagnosis: discordance between patients and physicians in primary care settings.
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DOI：
10.1186/1471-2296-9-1
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发表时间：
2008-01-03
影响因子：
2.9
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中科院分区：
文献类型：
--
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使用评估工具（PHQ-9）检查抑郁症症状与临床访视期间相同症状的医生记录之间的一致性，然后检查这些症状的存在如何影响初级保健环境中的抑郁症诊断。访问者管理调查和医疗记录审查。从两个大型城市初级保健社区的2321名参与者中招募了304名参与者进行抑郁症筛查。在2321名接受抑郁症筛查的参与者中，304名抑郁症呈阳性，其中75.3%（n = 229）的参与者患有显著抑郁症（PHQ-9评分≥ 10）。其中，31.0%被医生诊断为抑郁症。共有57.6%（n = 175）的研究参与者有显着的抑郁症状和功能障碍。其中37.7%被医生诊断为抑郁症。Cohen的Kappa分析，用于确定使用PHQ-9和医生记录这些症状引起的抑郁症状之间的一致性，使用标准一致性评定量表显示所有抑郁症状只有轻微的一致性（0.001-0.101）。进一步的分析表明，只有自杀意念和嗜睡或失眠与医生诊断抑郁症的可能性增加相关（OR分别为5.41 P sig < .01和2.02 P sig < .05）。其他抑郁症状和慢性疾病对医生诊断抑郁症没有影响。三分之二的抑郁症患者在初级保健环境中未被诊断出来。虽然功能障碍增加了抑郁症的医生诊断率，结构化的评估和医生之间的协议引起和/或记录的症状在临床上遇到的是非常低的。自杀、嗜睡和失眠与抑郁症诊断率的增加相关，即使医生和自我报告的症状不同。强调对初级保健患者进行常规结构化筛查的干预措施也可能提高这些环境中抑郁症的诊断率。需要进一步的研究来探讨在初级保健环境中医生与患者接触时的抑郁症状评估。
To examine the agreement between depression symptoms using an assessment tool (PHQ-9), and physician documentation of the same symptoms during a clinic visit, and then to examine how the presence of these symptoms affects depression diagnosis in primary care settings. Interviewer administered surveys and medical record reviews. A total of 304 participants were recruited from 2321 participants screened for depression at two large urban primary care community settings. Of the 2321 participants screened for depression 304 were positive for depression and of these 75.3% (n = 229) were significantly depressed (PHQ-9 score ≥ 10). Of these, 31.0% were diagnosed by a physician with a depressive disorder. A total of 57.6% (n = 175) of study participants had both significant depression symptoms and functional impairment. Of these 37.7% were diagnosed by physicians as depressed. Cohen's Kappa analysis, used to determine the agreement between depression symptoms elicited using the PHQ-9 and physician documentation of these symptoms showed only slight agreement (0.001–0.101) for all depression symptoms using standard agreement rating scales. Further analysis showed that only suicidal ideation and hypersomnia or insomnia were associated with an increased likelihood of physician depression diagnosis (OR 5.41 P sig < .01 and (OR 2.02 P sig < .05 respectively). Other depression symptoms and chronic medical conditions had no affect on physician depression diagnosis. Two-thirds of individuals with depression are undiagnosed in primary care settings. While functional impairment increases the rate of physician diagnosis of depression, the agreement between a structured assessment and physician elicited and or documented symptoms during a clinical encounter is very low. Suicidality, hypersomnia and insomnia are associated with an increase in the rate of depression diagnosis even when physician and self report of the symptom differ. Interventions that emphasize the use of routine structured screening of primary care patients might also improve the rate of diagnosis of depression in these settings. Further studies are needed to explore depression symptom assessment during physician patient encounter in primary care settings.