Yates William R, Mitchell Jeff, John Rush A, Trivedi Madhukar, Wisniewski Stephen R, Warden Diane, Bryan Charlene, Fava Maurizio, Husain Mustafa M, Gaynes Bradley N
Department of Psychiatry, University of Oklahoma College of Medicine, Tulsa, OK, USA.
Prim Care Companion J Clin Psychiatry. 2007;9(1):7-15. doi: 10.4088/pcc.v09n0102.
Concurrent medical comorbidity influences the accurate diagnosis and treatment of major depressive disorder (MDD).
The objective of this study was to validate previous findings from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study using a confirmation analysis in a previously unanalyzed cohort.
Baseline cross-sectional case-control study of patients enrolling in a prospective randomized multistage treatment study of nonpsychotic MDD.
Fourteen regional U.S. centers representing 18 primary care and 23 psychiatric practices.
2541 outpatients with DSM-IV nonpsychotic MDD.
Sociodemographic status, medical illness ratings, psychiatric status, quality of life, and DSM-IV depression symptom ratings.
The prevalence of significant general medical comorbidity in this population was 50.0% (95% CI = 48.1% to 52.0%), consistent with findings reported for the first cohort. Concurrent significant medical comorbidity was associated with older age, lower income, unemployment, limited education, and longer duration of index depressive episode. The group with significant medical comorbidity reported higher rates of somatic symptoms, gastrointestinal symptoms, sympathetic arousal, and leaden paralysis. These results were generally consistent between the 2 cohorts from STAR*D.
Major depressive disorder with concurrent general medical conditions is associated with a specific sociodemographic profile and pattern of depressive symptoms. This association has implications for diagnosis and clinical care.
并存的躯体疾病共病影响重度抑郁症（MDD）的准确诊断和治疗。
本研究的目的是在一个先前未分析的队列中，通过验证性分析来验证先前从缓解抑郁的序贯治疗方案（STAR*D）研究中得到的结果。
对参加非精神病性MDD前瞻性随机多阶段治疗研究的患者进行基线横断面病例对照研究。
代表18个初级保健机构和23个精神科机构的美国14个地区中心。
2541例符合《精神疾病诊断与统计手册》第四版（DSM-IV）标准的非精神病性MDD门诊患者。
社会人口学状况、躯体疾病评分、精神状态、生活质量以及DSM-IV抑郁症状评分。
该人群中显著的躯体疾病共病患病率为50.0%（95%置信区间=48.1%至52.0%），与第一个队列报告的结果一致。并存的显著躯体疾病共病与年龄较大、收入较低、失业、教育程度有限以及首次抑郁发作持续时间较长有关。有显著躯体疾病共病的组报告的躯体症状、胃肠道症状、交感神经兴奋和铅样麻痹发生率较高。这些结果在STAR*D研究的两个队列之间总体上是一致的。
伴有并存躯体疾病的重度抑郁症与特定的社会人口学特征和抑郁症状模式相关。这种关联对诊断和临床护理具有重要意义。
