Patten Scott B
Alberta Heritage Foundation for Medical Research, Department of Community Health Sciences, Department of Psychiatry, University of Calgary, Calgary, Alberta.
Can J Psychiatry. 2002 Oct;47(8):775-80. doi: 10.1177/070674370204700810.
Generally, public health strategies for major depression have focused on case-finding, public and professional education, and disease-management strategies. In principle, increased rates of treatment utilization and improved treatment outcomes should lead to improved mental health at the population level. Progress of this sort, however, has been difficult to confirm.
The National Population Health Survey (NPHS) is a large-scale longitudinal study of a representative sample drawn from the Canadian population. To date, Statistics Canada has released data from 3 NPHS cycles: 1994-1995, 1996-1997, and 1998-1999. Treatment utilization and major depression measures were employed in the NPHS survey, providing a unique source of longitudinal Canadian data. In this study, major depression point prevalence (defined using a predictive instrument for annual major depressive episode [MDE] prevalence and responses from a distress scale) and associated treatment utilization were evaluated over time.
Between 1994-1995 and 1995-1996, the proportion of persons with depression receiving antidepressant treatment increased dramatically, from 18.2% (12.3% to 22.1%) in 1994-1995 to 32.6% (23.0% to 42.2%) in 1998-1999. Point prevalence of major depression was 2.4%, 1.8%, and 1.9% in the 3 NPHS iterations.
Data from the NPHS suggest public health progress against major depression in Canada. More people with major depression in Canada are receiving treatment, and these changes may have been associated with improved population health status. However, both random variation and extraneous societal factors could account for the observed trends in prevalence. It is impossible to relate changes in utilization directly to population health status using the NPHS data.
一般而言，针对重度抑郁症的公共卫生策略主要集中在病例发现、公众和专业教育以及疾病管理策略上。原则上，治疗利用率的提高和治疗效果的改善应能在人群层面改善心理健康状况。然而，此类进展难以得到证实。
全国人口健康调查（NPHS）是一项对从加拿大人口中抽取的具有代表性样本进行的大规模纵向研究。迄今为止，加拿大统计局已发布了3个NPHS周期的数据：1994 - 1995年、1996 - 1997年和1998 - 1999年。NPHS调查采用了治疗利用率和重度抑郁症测量方法，提供了加拿大纵向数据的独特来源。在本研究中，对重度抑郁症的点患病率（使用年度重度抑郁发作[MDE]患病率预测工具和痛苦量表的反应来定义）及相关治疗利用率随时间进行了评估。
在1994 - 1995年至1998 - 1999年期间，接受抗抑郁治疗的抑郁症患者比例大幅上升，从1994 - 1995年的18.2%（12.3%至22.1%）增至1998 - 1999年的32.6%（23.0%至42.2%）。在3个NPHS周期中，重度抑郁症的点患病率分别为2.4%、1.8%和1.9%。
NPHS的数据表明加拿大在防治重度抑郁症方面取得了公共卫生进展。加拿大有更多的重度抑郁症患者正在接受治疗，这些变化可能与人群健康状况的改善有关。然而，随机变异和外部社会因素都可能解释所观察到的患病率趋势。使用NPHS数据无法直接将利用率的变化与人群健康状况联系起来。
