Coultas David B, Edwards Drew W, Barnett Bethany, Wludyka Peter
The University of Texas Health Center at Tyler, Tyler, TX 75708, USA.
COPD. 2007 Mar;4(1):23-8. doi: 10.1080/15412550601169190.
While depression is a common co-morbid condition among patients with COPD, little is known about predictors or health impact of depression among these patients. To address these gaps in knowledge we conducted a cross-sectional survey of 207 patients with COPD cared for in a network of primary care clinics affiliated with an urban academic health center. A standardized questionnaire was used to measure demographic characteristics, smoking status, co-morbid medical conditions, current medications, self-efficacy, social support, illness intrusiveness, and self-reported health care utilization during the previous 6 months. Depressive symptoms were assessed using the Centers for Epidemiologic Studies-Depression scale. Overall, the prevalence of moderate to high levels of depressive symptoms was 60.4%. In a multivariate analysis independent predictors of depressive symptoms were being a former smoker (OR = 0.41 (95% CI 0.19-0.89)), higher self-efficacy (OR = 0.42 (0.28-0.64)), higher social support (OR = 0.72 (0.52-0.99)), and higher perceived illness intrusiveness (OR = 1.05 (1.02-1.08)). Depressive symptoms were associated with increased physician visits, emergency room visits, and hospitalizations for lung disease. In conclusion, depressive symptoms are common among patients with COPD and associated with an increase in healthcare utilization. These findings suggest that the identification of risk factors for depressive symptoms (e.g., continued smoking) may increase detection and improve management of depression and health outcomes among patients with COPD.
虽然抑郁症是慢性阻塞性肺疾病（COPD）患者中常见的共病情况，但对于这些患者中抑郁症的预测因素或健康影响知之甚少。为了填补这些知识空白，我们对在一家城市学术健康中心附属的初级保健诊所网络中接受治疗的207例COPD患者进行了横断面调查。使用标准化问卷来测量人口统计学特征、吸烟状况、共病医疗状况、当前用药情况、自我效能感、社会支持、疾病侵扰程度以及过去6个月内自我报告的医疗保健利用情况。使用流行病学研究中心抑郁量表评估抑郁症状。总体而言，中度至高度抑郁症状的患病率为60.4%。在多变量分析中，抑郁症状的独立预测因素包括曾经吸烟（比值比[OR]=0.41[95%置信区间（CI）0.19 - 0.89]）、较高的自我效能感（OR = 0.42[0.28 - 0.64]）、较高的社会支持（OR = 0.72[0.52 - 0.99]）以及较高的感知疾病侵扰程度（OR = 1.05[1.02 - 1.08]）。抑郁症状与看医生次数增加、急诊就诊次数增加以及肺部疾病住院次数增加有关。总之，抑郁症状在COPD患者中很常见，并且与医疗保健利用增加有关。这些发现表明，识别抑郁症状的风险因素（例如持续吸烟）可能会提高对抑郁症的检测，并改善COPD患者的抑郁症管理和健康结局。
