Cassano Paolo, Fava Maurizio
Depression Clinical and Research Program, Massachusetts General Hospital, 15 Parkman Street-ACC 812, , Boston, MA 02114, USA.
J Psychosom Res. 2002 Oct;53(4):849-57. doi: 10.1016/s0022-3999(02)00304-5.
Depressive disorders are a significant public health issue. They are prevalent, disabling, often chronic illnesses, which cause a high economic burden for society, related to both direct and indirect costs. Depressive disorders also influence significantly the outcome of comorbid medical illnesses such as cardiac diseases, diabetes, and cancer. In primary care, underrecognition and undertreatment of depressive disorders are common, despite their relatively high prevalence, which accounts typically for more than 10% of patients. Primary care physicians should be aware of the common risk factors for depressive disorders such as gender, neuroticism, life events and adverse childhood experiences, and they should be familiar with associated features such as a positive psychiatric family history and prior depressive episodes. In primary care settings, depressive disorders should be considered with patients with multiple medical problems, unexplained physical symptoms, chronic pain or use of medical services that is more frequent than expected. Management of depressive disorders in primary care should include treatment with the newer antidepressant agents (given the fact they are typically well tolerated and safe) and focus on concomitant unhealthy behaviors as well as treatment adherence, which may both affect patient outcome. Programs aimed at improving patient follow-up and the coordination of the primary care intervention with that of specialists have been found to improve patient outcomes and to be cost effective.
抑郁症是一个重大的公共卫生问题。它们普遍存在，会导致残疾，且常常是慢性疾病，给社会带来高昂的经济负担，涉及直接和间接成本。抑郁症还会显著影响合并存在的躯体疾病的预后，如心脏病、糖尿病和癌症。在初级保健中，尽管抑郁症患病率相对较高（通常占患者的10%以上），但对其认识不足和治疗不足的情况很常见。初级保健医生应了解抑郁症的常见危险因素，如性别、神经质、生活事件和不良童年经历，并且应熟悉相关特征，如阳性精神疾病家族史和既往抑郁发作史。在初级保健环境中，对于有多种躯体问题、不明原因的躯体症状、慢性疼痛或使用医疗服务比预期更频繁的患者，应考虑到抑郁症。初级保健中抑郁症的管理应包括使用新型抗抑郁药进行治疗（鉴于它们通常耐受性良好且安全），并关注伴随的不健康行为以及治疗依从性，这两者都可能影响患者的预后。旨在改善患者随访以及初级保健干预与专科医生干预协调性的项目已被发现可改善患者预后且具有成本效益。
