Comorbid mental disorders, depression symptom severity, and role impairment among Veterans initiating depression treatment through the Veterans Health Administration.
Comorbid mental disorders, depression symptom severity, and role impairment among Veterans initiating depression treatment through the Veterans Health Administration.
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DOI：
10.1016/j.jad.2021.04.033
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发表时间：
2021-07-01
影响因子：
6.6
通讯作者：
Kessler RC
中科院分区：
文献类型：
--
作者：
Ziobrowski HN;Leung LB;Bossarte RM;Bryant C;Keusch JN;Liu H;Puac-Polanco V;Pigeon WR;Oslin DW;Post EP;Zaslavsky AM;Zubizarreta JR;Kessler RC
精神共病可能使抑郁症的治疗复杂化，因为它与增加的角色障碍有关。然而，抑郁症状的严重程度可能解释了这些关联。了解抑郁症严重程度和合并症与损伤的独立关联有助于制定治疗计划。对于抑郁的退伍军人来说尤其如此，他们有很高的精神病合并症率。在退伍军人健康管理局（VHA）开始重度抑郁症治疗的2，610名退伍军人进行了基线自我报告调查，筛选了各种精神病合并症，并评估了抑郁症的严重程度和角色障碍。Logistic和广义线性回归模型估计抑郁症严重程度和合并症与损害的单变量和多变量关联。人群归因风险比例（PARP）估计了抑郁症严重程度和合并症在解释角色障碍方面的相对重要性。几乎所有患者（97.8%）至少有一种合并症筛查阳性，一半（49.8%）有4种以上合并症。最常见的阳性筛查是广泛性焦虑症（80.2%），创伤后应激障碍（77.9%）和恐慌/恐惧症（77.4%）。在多变量模型中，抑郁症的严重程度和合并症与损伤显著相关。在多变量与单变量模型中，抑郁症严重程度的相关性比合并症的相关性减弱得少。PARP表明，15-60%的角色障碍归因于抑郁症的严重程度，5-32%归因于合并症。筛查量表可能高估了合并症患病率。横断面观察设计不能确定时间或因果关系的优先级。虽然精神共病的积极筛查在抑郁的VHA患者中普遍存在，但抑郁的严重程度占这些共病与角色障碍的大部分关联。
Psychiatric comorbidities may complicate depression treatment by being associated with increased role impairments. However, depression symptom severity might account for these associations. Understanding the independent associations of depression severity and comorbidity with impairments could help in treatment planning. This is especially true for depressed Veterans, who have high psychiatric comorbidity rates. 2,610 Veterans beginning major depression treatment at the Veterans Health Administration (VHA) were administered a baseline self-report survey that screened for diverse psychiatric comorbidities and assessed depression severity and role impairments. Logistic and generalized linear regression models estimated univariable and multivariable associations of depression severity and comorbidities with impairments. Population attributable risk proportions (PARPs) estimated the relative importance of depression severity and comorbidities in accounting for role impairments. Nearly all patients (97.8%) screened positive for at least one comorbidity and half (49.8%) for 4+ comorbidities. The most common positive screens were for generalized anxiety disorder (80.2%), posttraumatic stress disorder (77.9%), and panic/phobia (77.4%). Depression severity and comorbidities were significantly and additively associated with impairments in multivariable models. Associations were attenuated much less for depression severity than for comorbidities in multivariable versus univariable models. PARPs indicated that 15-60% of role impairments were attributable to depression severity and 5-32% to comorbidities. The screening scales could have over-estimated comorbidity prevalence. The cross-sectional observational design cannot determine either temporal or causal priorities. Although positive screens for psychiatric comorbidity are pervasive among depressed VHA patients, depression severity accounts for most of the associations of these comorbidities with role impairments.
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