Weich Scott, Nazareth Irwin, Morgan Louise, King Michael
Health Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK.
Br J Psychiatry. 2007 Aug;191:164-9. doi: 10.1192/bjp.bp.106.032219.
Depression is prevalent, costly and often undertreated.
To test the hypothesis that people with low socio-economic status are least likely to receive and adhere to evidence-based treatments for depression, after controlling for clinical need.
Individuals with an ICD-10 depressive episode in the past 12 months (n=866) were recruited from 7271 attendees in 36 general practices in England and Wales. Depressive episodes were identified using the 12-month Composite International Diagnostic Interview. Treatment receipt and adherence were assessed by structured interview, and rated using evidence-based criteria.
We identified 332 individuals (38.3%) who received and adhered to evidence-based treatment. There were few socio-economic differences in treatment allocation. Although those without educational qualifications were least likely to receive psychological treatments (OR = 0.55,95% CI 0.34-0.89, P = 0.02), this association was not statistically significant after adjusting for depression severity.
We found no evidence of inverse care in the treatment of moderate and severe depression in primary care in England and Wales.
抑郁症普遍存在，代价高昂且常常治疗不足。
检验以下假设：在控制临床需求后，社会经济地位较低的人接受并坚持循证抑郁症治疗的可能性最小。
从英格兰和威尔士36家全科诊所的7271名就诊者中招募过去12个月内有ICD - 10抑郁发作的个体（n = 866）。使用12个月综合国际诊断访谈识别抑郁发作。通过结构化访谈评估治疗接受情况和依从性，并根据循证标准进行评分。
我们识别出332名（38.3%）接受并坚持循证治疗的个体。在治疗分配上几乎没有社会经济差异。虽然未受过教育的人接受心理治疗的可能性最小（比值比=0.55，95%置信区间0.34 - 0.89，P = 0.02），但在调整抑郁严重程度后，这种关联无统计学意义。
我们没有发现英格兰和威尔士初级保健中治疗中度和重度抑郁症存在反向医疗服务的证据。
