Tardieu Sophie, Bottero Alain, Blin Patrick, Bohbot Michael, Goni Sylvia, Gerard Alain, Gasquet Isabelle
Medical Evaluation Department, Assistance Publique-Hôpitaux de Marseille, Marseille, France.
BMC Fam Pract. 2006 Jan 30;7:5. doi: 10.1186/1471-2296-7-5.
Little is known about depressed patients' profiles and how they are managed. The aim of the study is to compare GPs and psychiatrists for 1 degrees) sociodemographic and clinical profile of their patients considered as depressed 2 degrees) patterns of care provision.
The study design is an observational cross-sectional study on a random sample of GPs and psychiatrists working in France. Consecutive inclusion of patients seen in consultation considered as depressed by the physician. GPs enrolled 6,104 and psychiatrists 1,433 patients.
sociodemographics, psychiatric profile, environmental risk factors of depression and treatment. All clinical data were collected by participating physicians; there was no direct independent clinical assessment of patients to check the diagnosis of depressive disorder.
Compared to patients identified as depressed by GPs, those identified by psychiatrists were younger, more often urban (10.5% v 5.4% - OR = 2.4), educated (42.4% v 25.4% - OR = 3.9), met DSM-IV criteria for depression (94.6% v 85.6% - OR = 2.9), had been hospitalized for depression (26.1% v 15.6% - OR = 2.0) and were younger at onset of depressive problems (all adjusted p < .001). No difference was found for psychiatric and somatic comorbidity, suicide attempt and severity of current depression. Compared to GPs, psychiatrists more often prescribed tricyclics and very novel antidepressants (7.8% v 2.3% OR = 5.0 and 6.8% v 3.0% OR = 3.8) with longer duration of antidepressant treatment. GPs' patients received more "non-conventional" treatment (8.8% v 2.4% OR = 0.3) and less psychotherapy (72.2% v 89.1% OR = 3.1) (all adjusted p < .001).
Differences between patients mainly concerned educational level and area of residence with few differences regarding clinical profile. Differences between practices of GPs and psychiatrists appear to reflect more the organization of the French care system than the competence of providers.
对于抑郁症患者的特征以及他们如何接受治疗，我们了解甚少。本研究的目的是比较全科医生（GPs）和精神科医生在以下两方面的情况：1）被视为患有抑郁症的患者的社会人口统计学和临床特征；2）护理提供模式。
本研究设计为一项对在法国工作的全科医生和精神科医生的随机样本进行的观察性横断面研究。连续纳入医生会诊时视为患有抑郁症的患者。全科医生纳入了6104名患者，精神科医生纳入了1433名患者。
社会人口统计学、精神科特征、抑郁症的环境风险因素及治疗情况。所有临床数据均由参与研究的医生收集；未对患者进行直接独立的临床评估以核实抑郁症诊断。
与被全科医生确诊为抑郁症的患者相比，被精神科医生确诊的患者更年轻，居住在城市的比例更高（10.5%对5.4%，比值比[OR]=2.4），受教育程度更高（42.4%对25.4%，OR=3.9），符合《精神疾病诊断与统计手册》第四版（DSM-IV）抑郁症标准（94.6%对85.6%，OR=2.9），因抑郁症住院的比例更高（26.1%对15.6%，OR=2.0），且抑郁问题发病时更年轻（所有校正p<0.001）。在精神科和躯体共病、自杀未遂及当前抑郁严重程度方面未发现差异。与全科医生相比，精神科医生更常开具三环类药物和新型抗抑郁药（7.8%对2.3%，OR=5.0；6.8%对3.0%，OR=3.8），且抗抑郁治疗持续时间更长。全科医生的患者接受更多“非传统”治疗（8.8%对2.4%，OR=0.3），接受心理治疗的比例更低（72.2%对89.1%，OR=3.1）（所有校正p<0.001）。
患者之间的差异主要涉及教育水平和居住地区，临床特征方面差异较小。全科医生和精神科医生治疗方式的差异似乎更多地反映了法国医疗体系的组织情况，而非医疗服务提供者的能力。
