Under detection of depression in primary care settings in low and middle-income countries: a systematic review and meta-analysis.
Under detection of depression in primary care settings in low and middle-income countries: a systematic review and meta-analysis.
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DOI：
10.1186/s13643-022-01893-9
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发表时间：
2022-02-05
影响因子：
3.7
通讯作者：
Prince M
中科院分区：
文献类型：
--
作者：
Fekadu A;Demissie M;Birhane R;Medhin G;Bitew T;Hailemariam M;Minaye A;Habtamu K;Milkias B;Petersen I;Patel V;Cleare AJ;Mayston R;Thornicroft G;Alem A;Hanlon C;Prince M
抑郁症是初级保健中最常见的精神障碍之一，但识别率很低。本综述的目的是确定初级保健临床医生对抑郁症的检测水平及其在低收入至中等收入国家（LMICs）研究中的决定因素。使用PubMed、PsycINFO、MEDLINE、EMBASE、LILAC和AJOL进行系统性综述和荟萃分析，不限制发表年份。研究中的偏倚风险通过有效公共卫生实践项目（EPHPP）进行评估。本综述的“金标准”诊断是基于9项患者健康问卷（PHQ-9;临界评分为5和10）、其他标准问卷和访谈量表或专家诊断。进行了荟萃分析，排除了对特殊人群的研究。合并数据的分析按诊断方法分层。共筛选了3159篇非重复出版物。其中包括9份出版物、2份多国研究报告和7份单一国家研究报告，构成12份国家级报告。研究的总体方法学质量良好。在12份报告中，有4份报告的抑郁检测率为0.0%，另有5份报告的抑郁检测率< 12%。PHQ-9是使用的主要工具：两份报告中的合并检测使用PHQ-9，临界点为5（合并样本量= 1426）为3.9%（95% CI = 2.3%，5.5%）;在使用PHQ-9临界评分10的4份报告中（合并样本量= 5481），合并检测率为7.0%（95% CI = 3.9%，10.2%）。抑郁的严重程度和自杀倾向与检测显著相关。虽然筛查工具的使用是一个重要的限制，但初级保健临床医生对抑郁症的检测率极低，这对扩大中低收入国家的心理保健构成了严重威胁。应优先采取干预措施，以提高检测能力。PROSPERO CRD 42016039704。在线版本包含补充材料，可通过10.1186/s13643-022-01893-9获得。
Depression is one of the commonest mental disorders in primary care but is poorly identified. The objective of this review was to determine the level of detection of depression by primary care clinicians and its determinants in studies from low- to middle-income countries (LMICs). A systematic review and meta-analysis was conducted using PubMed, PsycINFO, MEDLINE, EMBASE, LILAC, and AJOL with no restriction of year of publication. Risk of bias within studies was evaluated with the Effective Public Health Practice Project (EPHPP). “Gold standard” diagnosis for the purposes of this review was based on the 9-item Patient Health Questionnaire (PHQ-9; cutoff scores of 5 and 10), other standard questionnaires and interview scales or expert diagnosis. Meta-analysis was conducted excluding studies on special populations. Analyses of pooled data were stratified by diagnostic approaches. A total of 3159 non-duplicate publications were screened. Nine publications, 2 multi-country studies, and 7 single-country studies, making 12 country-level reports, were included. Overall methodological quality of the studies was good. Depression detection was 0.0% in four of the twelve reports and < 12% in another five. PHQ-9 was the main tool used: the pooled detection in two reports that used PHQ-9 at a cutoff point of 5 (combined sample size = 1426) was 3.9% (95% CI = 2.3%, 5.5%); in four reports that used PHQ-9 cutoff score of 10 (combined sample size = 5481), the pooled detection was 7.0% (95% CI = 3.9%, 10.2%). Severity of depression and suicidality were significantly associated with detection. While the use of screening tools is an important limitation, the extremely low detection of depression by primary care clinicians poses a serious threat to scaling up mental healthcare in LMICs. Interventions to improve detection should be prioritized. PROSPERO CRD42016039704. The online version contains supplementary material available at 10.1186/s13643-022-01893-9.
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影响因子：
2.9
作者：
Rathod SD;Roberts T;Medhin G;Murhar V;Samudre S;Luitel NP;Selohilwe O;Ssebunnya J;Jordans MJD;Bhana A;Petersen I;Kigozi F;Nakku J;Lund C;Fekadu A;Shidhaye R
通讯作者：
Shidhaye R
影响因子：
2.2
作者：
Kamphuis, Marjolein H.;Stegenga, Bauke T.;Geerlings, Mirjam I.
通讯作者：
Geerlings, Mirjam I.
影响因子：
2.9
作者：
Fekadu, Abebaw;Medhin, Girmay;Hanlon, Charlotte
通讯作者：
Hanlon, Charlotte
影响因子：
2.9
作者：
Chin, Weng Yee;Chan, Kit T. Y.;Chiu, Billy C. F.
通讯作者：
Chiu, Billy C. F.
影响因子：
--
作者：
Kessler, D;Bennewith, O;Sharp, D
通讯作者：
Sharp, D