Olfson Mark, Marcus Steven C, Druss Benjamin, Elinson Lynn, Tanielian Terri, Pincus Harold Alan
Department of Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons of Columbia University, 1051 Riverside Dr, New York, NY 10032, USA.
JAMA. 2002 Jan 9;287(2):203-9. doi: 10.1001/jama.287.2.203.
Recent advances in pharmacotherapy and changing health care environments have focused increased attention on trends in outpatient treatment of depression.
To compare trends in outpatient treatment of depressive disorders in the United States in 1987 and 1997.
Analysis of service utilization data from 2 nationally representative surveys of the US general population, the 1987 National Medical Expenditure Survey (N = 34 459) and the 1997 Medical Expenditure Panel Survey (N = 32 636).
Respondents who reported making 1 or more outpatient visits for treatment of depression during that calendar year.
Rate of treatment, psychotropic medication use, psychotherapy, number of outpatient treatment visits, type of health care professional, and source of payment.
The rate of outpatient treatment for depression increased from 0.73 per 100 persons in 1987 to 2.33 in 1997 (P<.001). The proportion of treated individuals who used antidepressant medications increased from 37.3% to 74.5% (P<.001), whereas the proportion who received psychotherapy declined (71.1% vs 60.2%, P =.006). The mean number of depression treatment visits per user declined from 12.6 to 8.7 per year (P =.05). An increasingly large proportion of patients were treated by physicians for their condition (68.9% vs 87.3%, P<.001), and treatment costs were more often covered by third-party payers (39.3% to 55.2%, P<.001).
Between 1987 and 1997, there was a marked increase in the proportion of the population who received outpatient treatment for depression. Treatment became characterized by greater involvement of physicians, greater use of psychotropic medications, and expanding availability of third-party payment, but fewer outpatient visits and less use of psychotherapy. These changes coincided with the advent of better-tolerated antidepressants, increased penetration of managed care, and the development of rapid and efficient procedures for diagnosing depression in clinical practice.
药物治疗方面的最新进展以及不断变化的医疗环境，使得人们更加关注抑郁症门诊治疗的趋势。
比较1987年和1997年美国抑郁症门诊治疗的趋势。
对来自两项具有全国代表性的美国普通人群调查的服务利用数据进行分析，即1987年全国医疗支出调查（N = 34459）和1997年医疗支出小组调查（N = 32636）。
在该日历年报告因抑郁症进行了1次或更多次门诊就诊的受访者。
治疗率、精神药物使用情况、心理治疗、门诊治疗就诊次数、医疗保健专业人员类型以及支付来源。
抑郁症门诊治疗率从1987年的每100人0.73例增至1997年的2.33例（P<0.001）。使用抗抑郁药物的治疗个体比例从37.3%增至74.5%（P<0.001），而接受心理治疗的比例下降（71.1%对60.2%，P = 0.006）。每位使用者每年抑郁症治疗就诊的平均次数从12.6次降至8.7次（P = 0.05）。越来越大比例的患者由医生治疗其病情（68.9%对87.3%，P<0.001），治疗费用更多由第三方支付者承担（39.3%至55.2%，P<0.001）。
1987年至1997年间，接受抑郁症门诊治疗的人群比例显著增加。治疗的特点是医生参与度更高、精神药物使用更多、第三方支付的可及性扩大，但门诊就诊次数减少且心理治疗使用减少。这些变化与耐受性更好的抗抑郁药物的出现、管理式医疗的渗透率增加以及临床实践中快速有效的抑郁症诊断程序的发展相吻合。
