Hickie I, Burke D, Tobin M, Mutch C
The University of New South Wales, Sydney, Australia.
Aust N Z J Psychiatry. 2000 Oct;34(5):748-54. doi: 10.1080/j.1440-1614.2000.00805.x.
The objective of this study was to examine the impact of the organisation of mental health services on the quality of medical and psychiatric assessment provided to patients with depression over 50 years of age.
A retrospective clinical audit of 99 patients with primary depressive disorders who were over 50 years of age was used. These patients were assessed initially by specialised psychogeriatric outpatient and community services (44%), community-based adult mental health services (35%) or an inpatient service (21%). At 2-3 years follow up, clinical outcomes were rated by treating physicians and included current depression status, cognitive and medical status, course of illness since initial assessment and current living circumstances.
Patients who were assessed by the community-based adult mental health service received the least comprehensive assessment. Although these patients were more likely to be living independently, they tended to have the poorest depression outcome. Patients who were assessed by the specialised or inpatient services received more comprehensive initial assessment and better coordinated long-term care. Although these patients had more medical and cognitive comorbidity they had better overall depression outcomes.
Within a service system that determines access according to an arbitrary age of onset, patients with depression receive the best assessment from specialised psychogeriatric services. However, patients with an early age of onset, more chronic disorders and poor outcomes are treated largely within community-based adult services. Psychiatric services need to ensure that all older patients with depression receive appropriate biomedical and psychosocial assessment, as well as continuity of medical and psychological treatment.
本研究的目的是探讨心理健康服务的组织方式对50岁以上抑郁症患者所接受的医学和精神科评估质量的影响。
对99例50岁以上的原发性抑郁症患者进行回顾性临床审计。这些患者最初由专门的老年精神科门诊和社区服务机构（44%）、社区成人心理健康服务机构（35%）或住院服务机构（21%）进行评估。在2至3年的随访中，由治疗医生对临床结果进行评分，包括当前的抑郁状态、认知和医学状态、自初次评估以来的病程以及当前的生活状况。
由社区成人心理健康服务机构评估的患者接受的评估最不全面。尽管这些患者更有可能独立生活，但他们的抑郁结局往往最差。由专门服务机构或住院服务机构评估的患者接受了更全面的初次评估和更协调的长期护理。尽管这些患者有更多的医学和认知合并症，但他们的总体抑郁结局更好。
在一个根据任意发病年龄确定就诊机会的服务系统中，抑郁症患者从专门的老年精神科服务中获得最佳评估。然而，发病年龄早、病情更慢性且结局较差的患者主要在社区成人服务机构接受治疗。精神科服务需要确保所有老年抑郁症患者都能接受适当的生物医学和心理社会评估，以及医学和心理治疗的连续性。
