An international study of the relation between somatic symptoms and depression
An international study of the relation between somatic symptoms and depression
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DOI：
10.1056/nejm199910283411801
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发表时间：
1999-10-28
影响因子：
158.5
通讯作者：
Ormel, J
中科院分区：
文献类型：
--
作者：
Simon, GE;VonKorff, M;Ormel, J
背景抑郁症患者，尤其是初级保健医生所见的抑郁症患者，可能会报告躯体症状，如头痛、便秘、虚弱或背痛。以前的一些研究表明，在非西方国家的患者更有可能报告躯体症状比西方countries.Methods的患者，我们使用的数据从世界卫生组织的心理问题的研究，在一般的医疗保健检查躯体症状和抑郁症之间的关系。该研究于1991年和1992年进行，在5大洲14个国家的15个初级保健中心筛选了25，916名患者。共有5447例患者进行了抑郁和躯体形式障碍的结构化评估。结果共有1146例患者（加权患病率，10.1%）符合重度抑郁症的标准。仅报告躯体症状的抑郁症患者的范围为45%至95%（总患病率为69%;中心间比较P=0.002）。躯体表现在患者与初级保健医生缺乏持续关系的中心比在大多数患者有私人医生的中心更常见（比值比，1.8; 95%置信区间，1.2至2.7）。一半的抑郁症患者报告了多种无法解释的躯体症状，11%的人在直接询问时否认了抑郁症的心理症状。这些比例在各中心之间均无显著差异。虽然抑郁症状的总体患病率显着不同的中心，心理和身体症状的频率是similar.Conclusions躯体症状的抑郁症是常见的，在许多国家，但其频率取决于如何躯体化的定义。抑郁症患者出现严格躯体症状的频率存在很大差异。在某种程度上，这种差异可能反映了医生和医疗保健系统的特点，以及患者之间的文化差异。（N Engl J Med 1999;341：1329-35.）(C)1999年，马萨诸塞州医学会。
Background Patients with depression, particularly those seen by primary care physicians, may report somatic symptoms, such as headache, constipation, weakness, or back pain. Some previous studies have suggested that patients in non-Western countries are more likely to report somatic symptoms than are patients in Western countries.Methods We used data from the World Health Organization's study of psychological problems in general health care to examine the relation between somatic symptoms and depression. The study, conducted in 1991 and 1992, screened 25,916 patients at 15 primary care centers in 14 countries on 5 continents. A total of 5447 of the patients underwent a structured assessment of depressive and somatoform disorders.Results A total of 1146 patients (weighted prevalence, 10.1 percent) met the criteria for major depression. The range of patients with depression who reported only somatic symptoms was 45 to 95 percent (overall prevalence, 69 percent; P=0.002 for the comparison among centers). A somatic presentation was more common at centers where patients lacked an ongoing relationship with a primary care physician than at centers where most patients had a personal physician (odds ratio, 1.8; 95 percent confidence interval, 1.2 to 2.7). Half the depressed patients reported multiple unexplained somatic symptoms, and 11 percent denied psychological symptoms of depression on direct questioning. Neither of these proportions varied significantly among the centers. Although the overall prevalence of depressive symptoms varied markedly among the centers, the frequencies of psychological and physical symptoms were similar.Conclusions Somatic symptoms of depression are common in many countries, but their frequency varies depending on how somatization is defined. There is substantial variation in how frequently patients with depression present with strictly somatic symptoms. In part, this variation may reflect characteristics of physicians and health care systems, as well as cultural differences among patients. (N Engl J Med 1999;341:1329-35.) (C) 1999, Massachusetts Medical Society.