Outcomes of Subsyndromal Depression in Older Primary Care Patients
Outcomes of Subsyndromal Depression in Older Primary Care Patients
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DOI：
10.1097/jgp.0b013e3181cb87d6
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发表时间：
2010-03-01
影响因子：
7.2
通讯作者：
Lyness, Jeffrey M.
中科院分区：
文献类型：
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作者：
Grabovich, Andrew;Lu, Naiji;Lyness, Jeffrey M.
目标：大多数在初级保健中患有临床显着抑郁症状的老年人不符合重度或轻度抑郁症的标准。作者检验了这样的假设：亚综合征抑郁症 (SSD) 患者在随访时的精神、医疗和功能结果会比非抑郁患者差，但不会像轻度或重度抑郁症患者那么差。作者还探讨了 SSD 的三种定义的相对结果，以确定它们的相对预后价值。设计：前瞻性观察队列研究。地点：纽约州门罗县的初级保健实践。参与者：481 名 65 岁及以上的初级保健患者，他们在入院时完成了研究评估，并完成了至少 1 年的随访评估。测量：抑郁症诊断和 SSD 的三个定义是通过精神障碍诊断和统计手册第四版结构化临床访谈和 24 项汉密尔顿抑郁评定量表确定的。其他经过验证的措施评估了焦虑、认知、医疗负担和功能状态。结果：在精神症状和功能状态方面，SSD 患者的 1 年滞后结果比非抑郁症受试者差，通常与重度或轻度抑郁症没有显着差异。其中两个 SSD 定义识别出的受试者的精神和功能结果比第三个 SSD 定义更差。结论：临床医生在护理 SSD 患者时应保持警惕，监测持续或恶化的抑郁症状，包括自杀、焦虑、认知障碍和功能下降。研究人员可以使用特定的 SSD 定义来识别不良结果风险较高的个体，更好地了解 SSD 与功能障碍的关系，并测试创新的预防和治疗干预措施。 （《美国老年精神病学杂志》2010 年；18：227-235）
Objectives: Most older persons in primary care suffering clinically significant depressive symptoms do not meet criteria for major or minor depression. The authors tested the hypothesis that patients with subsyndromal depression (SSD) would have poorer psychiatric, medical, and functional outcomes at follow-up than nondepressed patients but not as poor as those with minor or major depression. The authors also explored the relative outcomes of three definitions of SSD to determine their relative prognostic value. Design: Prospective observational cohort study. Setting: Primary care practices in Monroe County, NY. Participants: Four hundred eighty-one primary care patients aged 65 years and older who completed research assessments at intake and at least 1 year of follow-up evaluation. Measurements: Depression diagnoses and three definitions of SSD were determined by the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and the 24-item Hamilton Depression Rating Scale. Other validated measures assessed anxiety, cognition, medical burden, and functional status. Results: Patients with SSD had poorer 1-year lagged outcomes than nondepressed subjects in terms of psychiatric symptoms and functional status, often not significantly different than major or minor depression. Two of the SSD definitions identified subjects with poorer psychiatric and functional outcomes than the third SSD definition. Conclusions: Clinicians should be vigilant in caring for patients with SSD, monitoring for persistent, or worsening depressive symptoms including suicidality, anxiety, cognitive impairment, and functional decline. Researchers may use particular SSD definitions to identify individuals at higher risk of poor outcomes, to better understand the relationships of SSD to functional disability, and to test innovative preventive and therapeutic interventions. (Am J Geriatr Psychiatry 2010; 18: 227-235)