Depression in Primary Care 2: General Practitioners' Recognition of Major Depression in Elderly Patients
Depression in Primary Care 2: General Practitioners' Recognition of Major Depression in Elderly Patients
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基层医疗中的抑郁症2：全科医生对老年患者重度抑郁症的认识
DOI：
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发表时间：
2001
影响因子：
7
通讯作者：
Ann Bruce
中科院分区：
文献类型：
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作者：
Daniel T. O'Connor;R. Rosewarne;Ann Bruce
背景：重要的是，严重的抑郁症被初级保健医生识别和适当的治疗。本期的这篇文章和前一篇文章探讨了（a）老年患者决定向医生报告抑郁症状的因素和（B）全科医生（GP）在抑郁症出现时对抑郁症的认识。研究方法：使用堪培拉老年人访谈对澳大利亚墨尔本30名全科医生的1，021名70岁以上患者进行了分层样本调查，该调查产生了严格的ICD-10研究诊断。结果如下：全科医生对抑郁症的评级最好按照患者过去与精神科医生的接触、医生认为患者没有痴呆症、当前抑郁症状的数量、患者对这些症状的披露以及当前身体疼痛的重要性降序进行预测。在35例ICD-10轻度抑郁发作和26例中度或重度抑郁发作中，医生对患者情绪的评估与研究诊断一致的有23例（66%）。然而，全科医生对许多抑郁症状并不知情，他们经常将患者评定为抑郁，而实际上他们并不抑郁。结论：使用一个简单的抑郁症状检查表将导致医生对患者当前精神状态的了解的显著改善。
Background: It is important that serious depressive illness be recognized and treated appropriately by primary care practitioners. This and the preceding article in this issue examine (a) factors responsible for older patients' decision to report depressive symptoms to their doctor and (b) general practitioners' (GPs') recognition of depression when it was present. Methods: A survey was conducted of a stratified sample of 1,021 patients aged 70+ years of 30 GPs in Melbourne, Australia, using the Canberra Interview for the Elderly, which generates rigorous ICD-10 research diagnoses. Results: GPs' ratings of depression were best predicted in descending order of importance by patients' past contact with a psychiatrist, the doctor's view that a patient did not have dementia, the number of current depressive symptoms, patients' disclosure of these symptoms, and current physical pain. Physicians' assessments of patients' mood concurred with research diagnoses in 23 of 35 (66%) cases of ICD-10 mild depressive episode and 23 of 26 (88%) cases of moderate or severe depressive episode. GPs were unaware, however, of many depressive symptoms and often rated patients as being depressed when they were not. Conclusion: The use of a simple checklist of depressive symptoms would lead to a dramatic improvement in doctors' knowledge of patients' current psychiatric status.