Bergus George R, Hartz Arthur J, Noyes Russell, Ward Marcia M, James Paul A, Vaughn Thomas, Kelley Patricia L, Sinift Suzanne D, Bentler Suzanne, Tilman Eileen
Department of Family Medicine, Carver College of Medicine, University of Iowa, Iowa City 52242, USA.
J Rural Health. 2005 Fall;21(4):303-9. doi: 10.1111/j.1748-0361.2005.tb00099.x.
Previous studies have found that routine screening for depression does not improve patient outcome unless it is combined with case management. However, these studies were conducted before the widespread use of SSRIs or in settings other than traditional primary care.
This study investigated whether screening for depressive symptoms improves outcomes for depressed patients seen in rural fee-for-service primary care offices.
Depression screening was conducted at 2 private rural clinics in Iowa using the PHQ-9. Patients with depressive symptoms were randomized to the control group or the intervention group, where providers were given completed PHQ-9 questionnaires at the baseline visit. The outcome PHQ-9 scores were assessed by telephone at 4, 10, and 24 weeks after the index visit.
A total of 861 patients were screened for depressive symptoms; 51 subjects enrolled in the trial. The intervention and control groups did not significantly differ with respect to changes in PHQ-9 scores at any of the 3 follow-up times. They also did not differ with respect to the proportion of subjects who were actively managed with medication or by referral to a mental health specialist: 46% vs 33% (P = .38) for all subjects and 50% vs 50% (P = .96) for subjects with major depression at baseline.
Screening for depressive symptoms with the PHQ-9 in 2 rural medical clinics did not significantly increase physicians' active management of depression or lead to improved patient outcomes.
先前的研究发现，常规的抑郁症筛查并不能改善患者的治疗结果，除非与病例管理相结合。然而，这些研究是在选择性5-羟色胺再摄取抑制剂（SSRI）广泛使用之前进行的，或是在传统初级保健以外的环境中进行的。
本研究调查了在农村按服务收费的初级保健诊所中，对抑郁症状进行筛查是否能改善抑郁症患者的治疗结果。
在爱荷华州的两家农村私人诊所使用患者健康问卷-9（PHQ-9）进行抑郁症筛查。有抑郁症状的患者被随机分为对照组或干预组，在基线访视时，为干预组的医疗服务提供者提供已填好的PHQ-9问卷。在首次访视后的4周、10周和24周通过电话评估患者健康问卷-9的最终得分。
共有861名患者接受了抑郁症状筛查；51名受试者参与了试验。在3次随访中的任何一次，干预组和对照组在患者健康问卷-9得分变化方面均无显著差异。在接受药物积极治疗或被转介至心理健康专家的受试者比例方面，两组也无差异：所有受试者中这一比例分别为46%和33%（P = 0.38），基线时患有重度抑郁症的受试者中这一比例分别为50%和50%（P = 0.96）。
在两家农村诊所使用患者健康问卷-9筛查抑郁症状，并未显著增加医生对抑郁症的积极管理，也未改善患者的治疗结果。
