Litofsky N Scott, Farace Elana, Anderson Frederick, Meyers Christina A, Huang Wei, Laws Edward R
Division of Neurosurgery, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA.
Neurosurgery. 2004 Feb;54(2):358-66; discussion 366-7. doi: 10.1227/01.neu.0000103450.94724.a2.
To study the incidence of depression among patients undergoing surgery for high-grade glioma, document factors associated with the presence of depression, and examine the relationship between depression and patient outcome.
Physician and patient reports of depression were analyzed immediately postoperatively and again 3 and 6 months after surgery for high-grade glioma. Physician-reported depression was defined according to the Diagnostic and Statistical Manual of Mental Disorders, ed 4. Patient self-assessment of depression was based on responses to questions contained in two validated functional status surveys. Concordance of physician- and patient-reported depression was examined, along with the extent of use of pharmacological treatment for depression. Additional outcomes examined included quality of life, survival, patient satisfaction, and posttreatment complications.
Data from 598 patients were analyzed. In the early postoperative period, physicians reported depression in 15% of patients, whereas 93% of patients reported symptoms consistent with depression. The incidence of patient self-reported depression remained similar at 3- and 6-month follow-up, whereas physician reported depression increased from 15% in the early postoperative period to 22% at both 3- and 6-month follow-up. Concordance between physician recognition of depression and treatment of depression was low initially (33%) and increased at 3 and 6 months (51 and 60%, respectively). As compared with patients who were not depressed, survival was shorter and complications were more common among depressed patients.
Symptoms of depression were common immediately after surgery for glioma, and they increased throughout the 6-month period after surgery. These findings support the hypothesis that clinically important depression is a common complication in patients with high-grade glioma. Concordance between physician recognition of depression and self-reports of depression by patients was low. Concordance between physician recognition of depression and initiation of pharmacological antidepressant therapy was fair in the early postoperative period and improved somewhat over the subsequent 6-month period; however, within the 6-month period after surgery for glioma, antidepressant therapy was provided for only 60% of patients in whom the physician recognized depressive symptoms and in only 15% of patients who self-reported symptoms of depression. Findings from this observational study suggest the need for a controlled trial that is designed to test the hypothesis that more attention to the identification of postoperative depression and aggressive treatment of depressive symptoms can improve the quality of life and survival of patients after surgery for high-grade glioma.
研究高级别胶质瘤手术患者中抑郁症的发生率，记录与抑郁症存在相关的因素，并探讨抑郁症与患者预后的关系。
对高级别胶质瘤手术后立即、术后3个月和6个月时医生和患者报告的抑郁症情况进行分析。医生报告的抑郁症根据《精神障碍诊断与统计手册》第4版进行定义。患者对抑郁症的自我评估基于对两项经过验证的功能状态调查中问题的回答。检查医生和患者报告的抑郁症的一致性，以及抑郁症药物治疗的使用程度。检查的其他结局包括生活质量、生存率、患者满意度和治疗后并发症。
分析了598例患者的数据。术后早期，医生报告15%的患者有抑郁症，而93%的患者报告有与抑郁症相符的症状。在3个月和6个月随访时，患者自我报告的抑郁症发生率保持相似，而医生报告的抑郁症从术后早期的15%增加到3个月和6个月随访时的22%。医生对抑郁症的识别与抑郁症治疗之间的一致性最初较低（33%），在3个月和6个月时增加（分别为51%和60%）。与未患抑郁症的患者相比，抑郁症患者的生存期较短，并发症更常见。
胶质瘤手术后抑郁症症状很常见，且在术后6个月内有所增加。这些发现支持了这样的假设，即具有临床意义的抑郁症是高级别胶质瘤患者的常见并发症。医生对抑郁症的识别与患者抑郁症自我报告之间的一致性较低。医生对抑郁症的识别与开始使用抗抑郁药物治疗之间的一致性在术后早期一般，在随后的6个月内有所改善；然而，在胶质瘤手术后6个月内，只有60%医生识别出有抑郁症状的患者以及只有15%自我报告有抑郁症状的患者接受了抗抑郁治疗。这项观察性研究的结果表明需要进行一项对照试验，以检验这样的假设，即更多地关注术后抑郁症的识别和积极治疗抑郁症状可以改善高级别胶质瘤手术后患者的生活质量和生存率。
