Paton J, Jenkins R, Scott J
WHO Collaborating Centre for Research and Training for Mental Health, Institute of Psychiatry, London, UK.
Soc Psychiatry Psychiatr Epidemiol. 2001 Sep;36(9):423-8. doi: 10.1007/s001270170019.
This paper addresses the prevention and treatment of depression in the general population. It argues that the public health burden of depression cannot be effectively tackled solely at the level of the treatment of individuals; in addition, coherent strategies by national governments are required. It summarises some of the public health interventions that were undertaken in England by the government to reduce the risk factors associated with depression in increase detection and treatment and to destigmatise this disorder. Lessons learned from this experience are described.
To assess the scope for collective public interventions, a national psychiatric morbidity study was commissioned. The Government set targets for reducing psychiatric morbidity and suicide. Research related to depression was commissioned. A public information strategy was launched to increase understanding and reduce stigma, including a five year 'Defeat Depression' Campaign. Particular attention was paid to updating General Practitioners in the recognition, detection and management of depression. Government departments worked with employers and trade union organisations to attempt to reduce work-induced stress. Universal and selective prevention measures aimed to reduce factors associated with depression, such as unemployment. Measures to reduce suicide include education of health and social care professionals, supporting high-risk groups and restricting access to means of suicide. The impact of these strategies is difficult to assess and will not be apparent until the national psychiatric morbidity study is repeated in 2001. The overall suicide rate fell by 11.7% in five years.
本文探讨普通人群中抑郁症的预防与治疗。文章认为，仅在个体治疗层面无法有效应对抑郁症带来的公共卫生负担；此外，各国政府还需制定连贯的策略。本文总结了英国政府为降低与抑郁症相关的风险因素、提高抑郁症的检测与治疗率以及消除对该疾病的污名化所采取的一些公共卫生干预措施，并描述了从这一经验中吸取的教训。
为评估集体公共干预措施的范围，委托开展了一项全国性精神疾病发病率研究。政府设定了降低精神疾病发病率和自杀率的目标。委托开展了与抑郁症相关的研究。发起了一项公共信息战略，以增进理解并减少污名化，其中包括一项为期五年的“战胜抑郁症”运动。特别关注对全科医生进行抑郁症识别、检测和管理方面的知识更新。政府部门与雇主和工会组织合作，试图减轻工作压力。普遍预防措施和选择性预防措施旨在减少与抑郁症相关的因素，如失业。减少自杀的措施包括对卫生和社会护理专业人员进行教育、支持高危群体以及限制获取自杀手段。这些策略的影响难以评估，在2001年重复进行全国性精神疾病发病率研究之前也不会显现。五年内总体自杀率下降了11.7%。
