SERVICE UTILIZATION AND SOCIAL MORBIDITY ASSOCIATED WITH DEPRESSIVE SYMPTOMS IN THE COMMUNITY
SERVICE UTILIZATION AND SOCIAL MORBIDITY ASSOCIATED WITH DEPRESSIVE SYMPTOMS IN THE COMMUNITY
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DOI：
10.1001/jama.267.11.1478
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发表时间：
1992-03-18
影响因子：
120.7
通讯作者：
KLERMAN, GL
中科院分区：
文献类型：
--
作者：
JOHNSON, J;WEISSMAN, MM;KLERMAN, GL
客观的。 - 估计社区中与抑郁症状相关的服务利用率和社会发病率。使用流行病学措施、人群归因风险进行估计。人群归因风险是一种复合衡量指标，既反映患有某种疾病的个体的发病风险，也反映该疾病在社区中的患病率。设计。 - 流行病学调查。参与者。 - 流行病学流域研究中的 18,571 名成年人从美国五个社区的复杂随机样本中进行了访谈。结果衡量。 - 自杀未遂、使用精神活性药物、自我报告的身体和情绪健康状况、工作时间损失以及一般医疗服务或因情绪问题而使用急诊室。结果。 - 根据结果变量的测量，重度抑郁-心境恶劣（终生患病率，6.1%）和抑郁症状（终生患病率，23.1%）与服务利用率和社会发病率的增加相关。然而，在人口基础上，抑郁症状与抑郁症或心境恶劣的临床状况一样多或更多的服务负担和损害与抑郁症相关。这种同等关联是由于抑郁症状的患病率较高而导致的。与抑郁症状（而非精神障碍）相关的人群归因风险百分比如下：使用急诊室（11.8%）或因情绪问题进行医疗咨询（21.5%）；使用镇静剂（14.6%）、安眠药（21.0%）或抗抑郁药（22.2%）；自我报告的情绪健康状况一般或较差（15.3%）；因工作损失的天数（17.8%）；和自杀未遂 (25.0%)。结论。 - 对人口归因风险的估计表明，医生实际上为更多有抑郁症状的人提供服务，而不是为患有正式定义的抑郁症的人提供服务。由于发病率高，亚临床抑郁症是一个临床和公共卫生问题。指出了对诊断和治疗问题的关注。
Objective. - To estimate service utilization and social morbidity in the community associated with depressive symptoms. Estimates were made using an epidemiologic measure, population attributable risk. Population attributable risk is a compound measure reflecting both the morbid risk to an individual with a disorder and the prevalence of the disorder in the community.Design. - Epidemiologic survey.Participants. - Eighteen thousand five hundred seventy-one adults in the Epidemiologic Catchment Area Study interviewed from a complex random sample in five US communities.Outcome Measures. - Suicide attempts, use of psychoactive medications, self-reported physical and emotional health, time lost from work, and general medical services or use of emergency departments for emotional problems.Results. - Major depression-dysthymia (lifetime prevalence, 6.1%) and depressive symptoms (lifetime prevalence, 23.1%) were associated with increased service utilization and social morbidity as measured by the outcome variables. On a population basis, however, as much or more service burden and impairment was associated with depressive symptoms as with the clinical conditions of depression or dysthymia. The equal association results from the greater prevalence of depressive symptoms. Population attributable risk percentages associated with depressive symptoms (not disorder) were as follows: emergency department use (11.8%) or medical consultations for emotional problems (21.5%); use of tranquilizers 14.6%), sleeping pills (21.0%), or antidepressants (22.2%); fair or poor self-reported emotional health (15.3%); days lost from work (17.8%); and suicide attempts (25.0%).Conclusions. - Estimates of population attributable risk indicated that physicians actually provided services to more persons with depressive symptoms than to persons with formally defined conditions of depressive disorders. Subclinical depression, as a consequence of high prevalence, is a clinical and public health problem. Attention to diagnostic and treatment issues is indicated.