Brugha T S, Bebbington P E
Department of Psychiatry, Leicester Royal Infirmary, UK.
Eur Arch Psychiatry Clin Neurosci. 1992;242(2-3):103-8. doi: 10.1007/BF02191556.
In spite of considerable progress in the establishment of physical and psychological treatments for major depression in clinical trials, little is known of the impact of treatment on the prevalence and course of depression in the population. Improved methods for assessing need for care have not yet been applied systematically to such a population. One hundred and thirty men and women attending psychiatric hospitals with depressive disorders were interviewed at the time of their initial contact. After a mean 4-month interval, 119 were reassessed in order to determine the extent to which potentially effective treatments were being fully deployed in those who had not made a complete recovery. Half had made a good recovery. At least 78% of those remaining at threshold level or above apparently had not been offered alternative, potentially effective physical or psychosocial treatment, and were therefore rated as having unmet need. Older male patients were less likely to have unmet need. This study thus raises doubts about the effectiveness of routine clinical management of depression. However, we will remain uncertain of how far the routine falls below the ideal until systematic needs for care procedures (Brewin et al. 1987) are applied prospectively to depressed populations.
尽管在临床试验中针对重度抑郁症的物理和心理治疗的建立取得了相当大的进展，但对于治疗对人群中抑郁症患病率和病程的影响却知之甚少。评估护理需求的改进方法尚未系统地应用于此类人群。130名因抑郁症而入住精神病院的男性和女性在初次就诊时接受了访谈。平均间隔4个月后，对119人进行了重新评估，以确定在那些尚未完全康复的患者中，潜在有效的治疗方法在多大程度上得到了充分应用。一半患者已康复良好。至少78%仍处于临界水平或以上的患者显然未得到替代的、潜在有效的物理或心理社会治疗，因此被评定为有未满足的需求。老年男性患者有未满足需求的可能性较小。因此，这项研究对抑郁症常规临床管理的有效性提出了质疑。然而，在将系统的护理需求程序（布鲁因等人，1987年）前瞻性地应用于抑郁症患者群体之前，我们仍不确定常规护理与理想护理的差距有多大。
