Watson Lea C, Lehmann Susan, Mayer Lawrence, Samus Quincy, Baker Alva, Brandt Jason, Steele Cynthia, Rabins Peter, Rosenblatt Adam, Lyketsos Constantine
Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
Am J Geriatr Psychiatry. 2006 Oct;14(10):876-83. doi: 10.1097/01.JGP.0000218698.80152.79.
The objective of this study was to obtain a direct estimate of the prevalence of depression, its associated factors, and rates of treatment among residents of assisted living (AL) facilities in central Maryland.
One hundred ninety-six AL residents were recruited from 22 (10 large and 12 small) randomly selected AL facilities in the city of Baltimore and seven Maryland counties. Chart review, staff and family history, comprehensive in-person resident evaluation, and the Cornell Scale for Depression in Dementia (CSDD) were administered by an experienced team of geriatric psychiatry clinicians. Those scoring >7 on the CSDD, a cut point repeatedly associated with poor outcomes, were considered clinically depressed.
Participants had an average age of 86 years, most were female and widowed, and 68% met consensus criteria for dementia. Twenty-four percent (47 of 196) of the sample was depressed. In bivariate analyses, depression was significantly related to medical comorbidity, need for activities of daily living (ADLs) assistance, more days spent in bed, and less participation in organized activities. After controlling for pertinent covariates in a regression model, only need for ADL assistance remained significantly associated with depression. Forty-three percent of those currently depressed were receiving antidepressants and were more likely to receive them if they lived in a large AL facility. Sixty percent of depressed residents had no regular source of psychiatric care.
In the first clinical study implemented by geriatric psychiatry professionals in AL, depression was found to be common, undertreated, and related to physical burden. AL is a rapidly growing segment of long-term care and represents an important setting in which to find and treat serious depression.
本研究的目的是直接估计马里兰州中部辅助生活（AL）设施居民中抑郁症的患病率、相关因素及治疗率。
从巴尔的摩市和马里兰州的七个县随机选取22家（10家大型和12家小型）AL设施，招募了196名AL居民。由经验丰富的老年精神病学临床医生团队进行病历审查、工作人员和家族史调查、全面的居民现场评估以及康奈尔痴呆抑郁量表（CSDD）评估。在CSDD上得分>7分（该切点反复与不良结局相关）的患者被认为患有临床抑郁症。
参与者的平均年龄为86岁，大多数为女性且丧偶，68%符合痴呆症的共识标准。样本中有24%（196人中的47人）患有抑郁症。在双变量分析中，抑郁症与合并症、日常生活活动（ADL）协助需求、卧床天数更多以及参与有组织活动较少显著相关。在回归模型中控制相关协变量后，仅ADL协助需求仍与抑郁症显著相关。目前患有抑郁症的患者中有43%正在接受抗抑郁药治疗，且如果他们住在大型AL设施中，更有可能接受治疗。60%的抑郁症居民没有常规的精神科护理来源。
在老年精神病学专业人员在AL设施开展的第一项临床研究中，发现抑郁症很常见、治疗不足且与身体负担有关。AL是长期护理中快速增长的一部分，是发现和治疗严重抑郁症的重要场所。
