Gallo Joseph J, Bogner Hillary R, Morales Knashawn H, Ford Daniel E
Department of Family Practice and Community Medicine, University of Pennsylvania, 3400 Spruce St, 2 Gates Pavilion, Philadelphia, PA 19104, USA.
Arch Intern Med. 2005 Sep 26;165(17):1962-8. doi: 10.1001/archinte.165.17.1962.
Black Americans are more likely to obtain mental health care from a primary care physician than from a mental health specialist. We investigated the association of ethnicity with the identification and active management of depression among older patients.
Cross-sectional survey of 355 older adults with and without significant depressive symptoms. At the index visit, the physician's ratings of depression and reports of active management were obtained on 341 of the 355 patients who completed in-home interviews.
Older black patients were less likely than older white patients to be identified as depressed (unadjusted odds ratio [OR], 0.40; 95% confidence interval [CI], 0.25-0.63) and their depression was less likely to be actively managed in the 6 months before the interview (unadjusted OR, 0.63; 95% CI, 0.19-2.16). In multivariate models that controlled for potentially influential characteristics such as patient age, sex, marital status, level of education, functional status, physical health, severity of depressive symptoms, severity of anxiety symptoms, attitudes about depression, number of office visits in the last 6 months, and the physician's rating of how well they knew the patient, the associations of identification (OR, 0.25; 95% CI, 0.17-0.39) and management (OR, 0.57; 95% CI, 0.19-1.77) with patient ethnicity remained substantially unchanged.
Our study calls attention to the role ethnicity may play in the identification and active management of depression among older primary care patients.
与从心理健康专家处获得心理健康护理相比，美国黑人更有可能从初级保健医生那里获得此类护理。我们调查了种族与老年患者抑郁症的识别及积极管理之间的关联。
对355名有或无显著抑郁症状的老年人进行横断面调查。在首次就诊时，从完成家庭访谈的355名患者中的341名患者处获得了医生对抑郁症的评分及积极管理报告。
与老年白人患者相比，老年黑人患者被识别为患有抑郁症的可能性较小（未调整优势比[OR]为0.40；95%置信区间[CI]为0.25 - 0.63），并且在访谈前6个月内其抑郁症得到积极管理的可能性也较小（未调整OR为0.63；95% CI为0.19 - 2.16）。在多变量模型中，控制了诸如患者年龄、性别、婚姻状况、教育程度、功能状态、身体健康状况（这部分原文表述有误，应是“身体健康状况”）、抑郁症状严重程度、焦虑症状严重程度、对抑郁症的态度、过去6个月内的就诊次数以及医生对其了解患者程度的评分等潜在影响因素后，识别（OR为0.25；95% CI为0.17 - 0.39）和管理（OR为0.57；95% CI为0.19 - 1.77）与患者种族之间的关联基本保持不变。
我们的研究提请注意种族在老年初级保健患者抑郁症的识别及积极管理中可能发挥的作用。
