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帕金森病退伍军人的抑郁症:发生率、合并症及医疗保健利用情况。

Depression in veterans with Parkinson's disease: frequency, co-morbidity, and healthcare utilization.

作者信息

Chen Peijun, Kales Helen C, Weintraub Daniel, Blow Frederic C, Jiang Lan, Ignacio Rosalinda V, Mellow Alan M

机构信息

Division of Geriatric Psychiatry, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.

出版信息

Int J Geriatr Psychiatry. 2007 Jun;22(6):543-8. doi: 10.1002/gps.1712.

Abstract

OBJECTIVE

To determine the frequency of depression in Parkinson's disease (PD) in routine clinical care, and to examine its association with co-morbid psychiatric and medical conditions and healthcare utilization.

METHODS

Depression diagnoses and healthcare utilization data for all male veterans with PD age 55 or older seen in fiscal year 2002 (n = 41,162) were analyzed using Department of Veterans Affairs (VA) national databases. Frequencies of co-morbid disorders and healthcare utilization were determined for depressed and non-depressed patients; associations with depression were examined using multivariate logistic regression models.

RESULTS

A depression diagnosis was recorded for 18.5% of PD patients, including major depression in 3.9%. Depression decreased in frequency and severity with increasing age. In multivariate logistic regression models, depressed patients had significantly greater psychiatric and medical co-morbidity, including dementia, psychosis, stroke, congestive heart failure, diabetes, and chronic obstructive pulmonary disease than non-depressed patients (all p < 0.01). Depressed PD patients were also significantly more likely to have medical (OR = 1.34, 95% CI = 1.25-1.44) and psychiatric hospitalizations (OR = 2.14, 95% CI = 1.83-2.51), and had more outpatient visits (p < 0.01), than non-depressed PD patients in adjusted models.

CONCLUSION

Depression in PD in non-tertiary care settings may not be as common or as severe as that seen in specialty care, though these findings also may reflect under-recognition or diagnostic imprecision. The occurrence of depression in PD is associated with greater psychiatric and medical co-morbidity, and greater healthcare utilization. These findings suggest that screening for depression in PD is important and should be embedded in a comprehensive psychiatric, neuropsychological, and medical evaluation.

摘要

目的

确定帕金森病(PD)在常规临床护理中的抑郁发生率,并研究其与共病的精神和躯体疾病以及医疗保健利用之间的关联。

方法

使用退伍军人事务部(VA)的国家数据库,分析了2002财年就诊的所有年龄在55岁及以上的男性PD退伍军人的抑郁诊断和医疗保健利用数据(n = 41,162)。确定了抑郁和非抑郁患者的共病疾病频率和医疗保健利用情况;使用多变量逻辑回归模型研究了与抑郁的关联。

结果

18.5%的PD患者有抑郁诊断记录,其中3.9%为重度抑郁。抑郁的频率和严重程度随年龄增长而降低。在多变量逻辑回归模型中,与非抑郁患者相比,抑郁患者的精神和躯体共病显著更多,包括痴呆、精神病、中风、充血性心力衰竭、糖尿病和慢性阻塞性肺疾病(所有p < 0.01)。在调整模型中,抑郁的PD患者也比非抑郁的PD患者更有可能接受医疗住院治疗(OR = 1.34,95% CI = 1.25 - 1.44)和精神科住院治疗(OR = 2.14,95% CI = 1.83 - 2.51),并且门诊就诊次数更多(p < 0.01)。

结论

在非三级医疗机构中,PD患者的抑郁可能不像在专科护理中那样常见或严重,尽管这些发现也可能反映出识别不足或诊断不准确。PD患者抑郁的发生与更多的精神和躯体共病以及更高的医疗保健利用率相关。这些发现表明,对PD患者进行抑郁筛查很重要,并且应该纳入全面的精神、神经心理和医学评估中。

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