Simon Gregory E, Fleck Marcelo, Lucas Ramona, Bushnell Donald M
Center for Health Studies, Group Health Cooperative of Puget Sound, 1730 Minor Ave., Number 1600, Seattle, WA 98101, USA.
Am J Psychiatry. 2004 Sep;161(9):1626-34. doi: 10.1176/appi.ajp.161.9.1626.
The purpose of the study was to evaluate the prevalence and predictors of depression treatment in a diverse cross-national sample of primary care patients.
At primary care facilities in six countries (Spain, Israel, Australia, Brazil, Russia, and the United States), a two-stage screening process was used to identify 1,117 patients with current depressive disorder. At baseline, all patients completed a structured diagnostic interview as well as measures of anxiety symptoms, alcohol use, chronic comorbid physical conditions, and perceived barriers to treatment. Primary care physicians were advised if the research interview indicated a probable depressive disorder in their patients. Three and 9 months later, participants reported all health services (including specialty mental health care and antidepressant medication) used in the preceding 3 months.
Across the six sites, the proportion of patients receiving any antidepressant pharmacotherapy ranged from a high of 38% in Seattle to a low of 0% in St. Petersburg; the proportion receiving any specialty mental health care varied from a high of 29% in Melbourne to a low of 3% in St. Petersburg. Patient characteristics were not consistently associated with receipt of either pharmacotherapy or specialty mental health care. Out-of-pocket cost was the most commonly reported barrier to treatment for depression; the percentage of patients who reported this barrier ranged from 24% in Barcelona to 75% in St. Petersburg.
Depression screening and physician notification are not sufficient to prompt adequate treatment for depression. The probability of treatment may be more influenced by characteristics of health care systems than by the clinical characteristics of individual patients. Financial barriers may be more important than stigma as impediments to appropriate care.
本研究旨在评估来自不同国家的基层医疗患者样本中抑郁症治疗的患病率及预测因素。
在六个国家（西班牙、以色列、澳大利亚、巴西、俄罗斯和美国）的基层医疗机构中，采用两阶段筛查流程来识别1117名当前患有抑郁症的患者。在基线时，所有患者均完成了结构化诊断访谈以及焦虑症状、饮酒情况、慢性合并身体疾病和感知到的治疗障碍的测量。如果研究访谈表明患者可能患有抑郁症，则会通知基层医疗医生。在3个月和9个月后，参与者报告了在前3个月内使用的所有医疗服务（包括专科心理健康护理和抗抑郁药物）。
在六个地点，接受任何抗抑郁药物治疗的患者比例从西雅图的38%（最高）到圣彼得堡的0%（最低）不等；接受任何专科心理健康护理的比例从墨尔本的29%（最高）到圣彼得堡的3%（最低）不等。患者特征与接受药物治疗或专科心理健康护理之间并无一致的关联。自付费用是最常被报告的抑郁症治疗障碍；报告这一障碍的患者比例从巴塞罗那的24%到圣彼得堡的75%不等。
抑郁症筛查和医生通知不足以促使对抑郁症进行充分治疗。治疗的可能性可能更多地受到医疗保健系统特征的影响，而非个体患者的临床特征。作为获得适当护理的障碍，经济障碍可能比耻辱感更为重要。
