Psychosocial problem disclosure by primary care patients.
Psychosocial problem disclosure by primary care patients.
复制标题
初级保健患者披露的心理社会问题。
DOI：
10.1016/s0277-9536(98)00439-0
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发表时间：
1999
期刊：
影响因子：
--
通讯作者：
Roter,DL
中科院分区：
文献类型：
--
作者：
Robinson,JW;Roter,DL
绝大多数有心理困扰的初级保健患者在就诊之初仅表现出躯体问题。然而，尚不清楚此类患者随后向其初级保健医生 (PCP) 披露心理社会问题的频率以及哪些变量可以预测此类披露。我们的目标是测量在心理困扰的初级保健患者中，披露心理社会问题（披露）的频率、PCP 之前的心理社会询问（事先询问）的影响以及各种患者变量对披露的影响，以及披露对 PCP 心理健康问题识别（识别）的影响。该研究基于 69 个社区 PCP 的实践，涉及 308 名成年患者，他们的 28 项一般健康问卷得分为 5 或更高，表明存在严重的心理困扰。 51% 的总体访问中发生了披露，67% 的访问中有事先询问。事先询问 (p<0.001)、医患熟悉度提高 (p<0.001) 以及患者心理困扰的严重程度 (p<0.001) 会增加披露的几率。先前询问和医患熟悉度之间存在负向交互作用（p<0.05），其大小小于任一变量的主效应，因此它们对披露的综合影响超过任一变量单独的影响，但小于乘法。调整显着协变量的影响后，已知披露的认可比值比估计为 24.13（95% 置信区间，11.28-51.63）。我们的结论是，如果 PCP 询问，大多数有心理困扰、躯体症状的患者会透露心理社会问题。对不熟悉的患者进行询问尤其有效。 PCP 只需在临床访谈中添加一两个有关情绪或人际问题的问题，就可以显着增加社会心理披露。
The vast majority of psychologically distressed primary care patients present exclusively somatic concerns at the outsets of their visits. However, it is not known how often such patients subsequently disclose psychosocial problems to their primary care physicians (PCPs) and what variables predict such disclosures. Our objectives were to measure, among psychologically distressed primary care patients, the frequency of disclosure of psychosocial problems (disclosure), the effects of prior psychosocial inquiry (prior inquiry) by PCPs and various patient variables on disclosure, and the effect of disclosure on mental health problem recognition (recognition) by PCPs. The study was based in the practices of 69 community-based PCPs and involved 308 adult patients with 28-item General Health Questionnaire scores of 5 or greater, indicating significant psychological distress. Disclosure occurred during 51% of visits overall and 67% of visits with prior inquiry. The odds of disclosure were increased by prior inquiry (p<0.001), greater physician–patient familiarity (p<0.001) and greater severity of patient psychological distress (p<0.001). Prior inquiry and physician–patient familiarity had a negative interaction (p<0.05) of smaller size than either variable's main effect, so that their combined effect on disclosure exceeded the effect of either variable alone but was less than multiplicative. The estimated odds ratio for recognition given disclosure was 24.13 (95% confidence interval, 11.28–51.63) after adjustment for the effects of significant covariates. We conclude that if PCPs inquire, most psychologically distressed, somatically presenting patients will disclose psychosocial problems. Inquiry is particularly productive with unfamiliar patients. PCPs can engender a substantial increase in psychosocial disclosure simply by adding one or two questions about mood or interpersonal problems to their clinical interviews.