Yates William R, Mitchell Jeff, Rush A John, Trivedi Madhukar H, Wisniewski Stephen R, Warden Diane, Hauger Robert B, Fava Maurizio, Gaynes Bradley N, Husain Mustafa M, Bryan Charlene
Department of Psychiatry, University of Oklahoma College of Medicine, Tulsa, OK 74135, USA.
Gen Hosp Psychiatry. 2004 Nov-Dec;26(6):421-9. doi: 10.1016/j.genhosppsych.2004.06.008.
A significant percentage of patients with major depressive disorder (MDD) suffer from concurrent general medical conditions (GMCs).
The objective of this preliminary report was to describe the rates of co-occurring significant GMCs and the clinical correlates and symptom features associated with the presence of GMCs.
Baseline cross-sectional case-control study of patients enrolling in a prospective randomized multistage treatment study of MDD.
Fourteen regional U.S. centers representing 19 primary care and 22 psychiatric practices.
One thousand five hundred outpatients with DSM-IV nonpsychotic MDD.
Sociodemographic status, medical illness ratings, psychiatric status, quality of life and DSM-IV depression symptom ratings.
The prevalence of significant medical comorbidity in this population was 52.8% (95% CI 50.3-55.3%). Concurrent significant medical comorbidity was associated with older age, lower income, unemployment, limited education, longer duration of index depressive episode and absence of self-reported family history of depression. Somatic symptoms common in MDD were endorsed at a higher rate in those with GMCs. Those without a GMC had higher rates of endorsement of impaired mood reactivity, distinct mood quality and interpersonal sensitivity.
Concurrent GMCs are common among outpatients with MDD in both primary care and specialty settings. Concurrent GMCs appear to influence the severity and symptom patterns in MDD and describe a vulnerable population with sociodemographic challenges to effective assessment and treatment.
相当比例的重度抑郁症（MDD）患者同时患有一般躯体疾病（GMCs）。
本初步报告的目的是描述共病显著GMCs的发生率以及与GMCs存在相关的临床关联和症状特征。
对参与MDD前瞻性随机多阶段治疗研究的患者进行基线横断面病例对照研究。
代表19个初级保健机构和22个精神科诊所的美国14个地区中心。
1500例符合《精神疾病诊断与统计手册》第四版（DSM-IV）非精神病性MDD的门诊患者。
社会人口统计学状况、躯体疾病评分、精神状态、生活质量和DSM-IV抑郁症状评分。
该人群中显著的躯体共病患病率为52.8%（95%可信区间50.3 - 55.3%）。同时存在显著的躯体共病与年龄较大、收入较低、失业、教育程度有限、首发抑郁发作持续时间较长以及无自我报告的抑郁症家族史相关。在患有GMCs的患者中，MDD常见的躯体症状的认可率更高。没有GMCs的患者对情绪反应受损、独特的情绪质量和人际敏感性的认可率更高。
在初级保健和专科环境中，MDD门诊患者中同时存在GMCs很常见。同时存在的GMCs似乎会影响MDD的严重程度和症状模式，并描述了一个在社会人口统计学方面面临有效评估和治疗挑战的脆弱人群。
