Wasan Ajay, Fernandez Ephrem, Jamison Robert N, Bhattacharyya Neil
Pain Management Center, Department of Anesthesia, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
Ann Otol Rhinol Laryngol. 2007 Jul;116(7):491-7. doi: 10.1177/000348940711600703.
We sought to determine the impact of psychiatric comorbidity on symptom density and resource utilization in chronic rhinosinusitis (CRS).
A prospective cohort of patients who sought evaluation of CRS was studied with the Rhinosinusitis Symptom Inventory and the Hospital Anxiety and Depression Scale. Data concerning symptom scores, symptom domains, and psychiatric comorbidity were analyzed to determine the interactions among psychiatric comorbidity, symptom reporting, and resource utilization in CRS.
We studied 143 patients (mean age, 43.4 years). Low, moderate, and high levels of anxiety were reported by 48.3%, 25.9%, and 25.9% of patients, respectively. Low, moderate, and high levels of depression were reported by 76.2%, 9.1%, and 14.7%. For the combined psychopathology group, 43.3%, 25.9%, and 30% had low, moderate, and high levels. Patients with high anxiety levels reported significant elevations of oropharyngeal symptoms (p = .013) and total symptoms (p = .030) in comparison with the low group. Patients with high depression levels reported higher oropharyngeal (p = .003), systemic (p = .001), and total symptom (p = .003) scores than did the low group. High combined psychopathology scores were associated with elevated facial, oropharyngeal, and systemic scores (p < .05). Regarding medical utilization, high anxiety levels or high combined psychopathology scores were associated with more frequent physician visits (p < .05). A high level of depression was associated with increased antibiotic use, missed workdays, and physician visits (p < .05).
High levels of anxiety and depression are common in patients who undergo evaluation for CRS. Psychiatric comorbidity is associated with increased symptoms in CRS and increased health-care utilization. Anxiety and depression should be identified in these patients to structure appropriate treatment.
我们试图确定精神共病对慢性鼻-鼻窦炎（CRS）症状密度和资源利用的影响。
对一组寻求CRS评估的前瞻性队列患者使用鼻-鼻窦炎症状量表和医院焦虑抑郁量表进行研究。分析有关症状评分、症状领域和精神共病的数据，以确定CRS中精神共病、症状报告和资源利用之间的相互作用。
我们研究了143例患者（平均年龄43.4岁）。分别有48.3%、25.9%和25.9%的患者报告有低、中、高水平的焦虑。分别有76.2%、9.1%和14.7%的患者报告有低、中、高水平的抑郁。在合并精神病理学组中，43.3%、25.9%和30%的患者有低、中、高水平。与低焦虑组相比，高焦虑水平的患者报告口咽症状（p = 0.013）和总症状（p = 0.030）显著升高。与低抑郁组相比，高抑郁水平的患者报告口咽（p = 0.003）、全身（p = 0.001）和总症状（p = 0.003）评分更高。高合并精神病理学评分与面部、口咽和全身评分升高相关（p < 0.05）。关于医疗利用，高焦虑水平或高合并精神病理学评分与更频繁的医生就诊相关（p < 0.05）。高水平的抑郁与抗生素使用增加、旷工天数增加和医生就诊增加相关（p < 0.05）。
接受CRS评估的患者中焦虑和抑郁水平较高很常见。精神共病与CRS症状增加和医疗保健利用增加相关。应在这些患者中识别焦虑和抑郁，以构建适当的治疗方案。
