Clinical versus patient-reported measures of depression in bariatric surgery.
Clinical versus patient-reported measures of depression in bariatric surgery.
复制标题
减肥手术中抑郁症的临床测量与患者报告的测量。
DOI：
10.1007/s00464-018-6101-8
复制
发表时间：
2018
期刊：
影响因子：
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通讯作者：
Ghaferi,AmirA
中科院分区：
文献类型：
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作者：
Srivatsan,Sudarshan;Guduguntla,Vinay;Young,KellyZ;Arastu,Aliasghar;Strong,CameronR;Cassidy,Ruth;Ghaferi,AmirA
背景：与无精神疾病的患者相比，患有精神疾病的减肥手术患者可能会经历更差的手术结果。抑郁症是美国肥胖症患者中最常见的心理健康诊断。准确的诊断和治疗对于降低围手术期风险至关重要。不幸的是，在手术前没有标准的方法来筛查患者的抑郁症。我们的目标是了解传统的临床筛查工具和一种新的患者报告的抑郁症筛查调查，患者健康问卷8（PHQ-8），在设置的减肥手术术前assessment.MethodsThe研究包括所有成人减肥手术患者从2014年1月至2016年6月之间的关系。没有使用PHQ-8和传统临床抑郁症筛查进行评估的患者被排除在研究之外。共有4486例患者符合合格性标准并纳入分析。我们使用比较统计学来研究这些筛查工具之间的关联，并测试人口统计学，手术，和社会经济factors.ResultsThe临床诊断抑郁症的研究队列的整体率为45.6%。相比之下，14.8%的患者使用PHQ-8筛查抑郁症呈阳性。在没有传统抑郁症临床诊断的患者中，10.2%的人使用PHQ-8筛查抑郁症呈阳性。这一子集的未确诊的患者更有可能是非白人，就业，并有较高的BMI比他们的临床诊断countermeasurements.Conclusions and Relevance我们发现，在我们的队列中，临床诊断抑郁症的发病率较高，与一般人群相比。然而，当使用经过验证的PHQ-8调查时，抑郁症的发病率更接近全国发病率。此外，通过当前临床评估，很大比例的患者未被诊断和/或误诊。使用有效的以患者为中心的工具进行标准化术前抑郁症筛查可以预防未经治疗的抑郁症的后果。
BackgroundBariatric surgery patients with mental illness may experience worse surgical outcomes compared to those without. Depression is the most prevalent mental health diagnosis amongst Americans with obesity. Accurate diagnosis and treatment is of paramount importance to mitigate perioperative risk. Unfortunately, there is no standard method to screen patients for depression prior to surgery. Our goal was to understand the relationship between traditional clinical screening tools and a novel patient-reported depression screening survey, Patient Health Questionnaire 8 (PHQ-8), in the setting of the bariatric surgery preoperative assessment.MethodsThe study included all adult bariatric surgery patients from January 2014 through June 2016. Patients who were not assessed using both the PHQ-8 and a traditional clinical depression screening were excluded from the study. There were a total of 4486 patients who met the eligibility criteria and were included in analysis. We used comparative statistics to examine the association between these screening tools and to test for contributing demographic, surgical, and socioeconomic factors.ResultsThe overall rate of clinically diagnosed depression in the study cohort was 45.6%. In comparison, 14.8% of all patients screened positive for depression using the PHQ-8. Of the patients without a traditional clinical diagnosis of depression, 10.2% screened positive for depression using the PHQ-8. This subset of undiagnosed patients was more likely to be non-white, employed, and had a higher BMI than their clinically diagnosed counterparts.Conclusions and RelevanceWe found a higher rate of clinically diagnosed depression in our cohort compared to the general population. However, when using the validated PHQ-8 survey, the rate of depression more closely approximated the national incidence. Further, a significant proportion of patients were undiagnosed and/or misdiagnosed by current clinical assessments. Standardizing preoperative depression screening using validated patient-centered tools may prevent the consequences of untreated depression.