Stromberg Ranja, Wernering Estera, Aberg-Wistedt Anna, Furhoff Anna-Karin, Johansson Sven-Erik, Backlund Lars G
Center for Family and Community Medicine, Department of Neurobiology, Caring Sciences and Society, Karolinska Institutet, Alfred Nobels allé 12, SE-14183 Huddinge, Sweden.
BMC Fam Pract. 2008 Jun 13;9:34. doi: 10.1186/1471-2296-9-34.
Only half of all depressions are diagnosed in Primary Health Care (PHC). Depression can remain undetected for a long time and entail high costs for care and low quality of life for the individuals. Drop in clinic is a common form of organizing health care; however the visits are short and focus on solving the most urgent problems. The aim of this study was to investigate the prevalence and severity of depression among women visiting the GPs' drop in clinic and to identify possible clues for depression among women.
The two-stage screening method with "high risk feedback" was used. Beck's Depression Inventory (BDI) was used to screen 155 women visiting two GPs' drop in clinic. Women who screened positive (BDI score > or =10) were invited by the GP to a repeat visit. Major depression (MDD) was diagnosed according to DSM-IV criteria and the severity was assessed with Montgomery-Asberg Depression Rating Scale (MADRS). Women with BDI score <10 constituted a control group. Demographic characteristics were obtained by questionnaire. Chart notations were examined with regard to symptoms mentioned at the index visit and were categorized as somatic or mental.
The two-stage method worked well with a low rate of withdrawals in the second step, when the GP invited the women to a repeat visit. The prevalence of depression was 22.4% (95% CI 15.6-29.2). The severity was mild in 43%, moderate in 53% and severe in 3%. The depressed women mentioned mental symptoms significantly more often (69%) than the controls (15%) and were to a higher extent sick-listed for a longer period than 14 days. Nearly one third of the depressed women did not mention mental symptoms. The majority of the women who screened as false positive for depression had crisis reactions and needed further care from health professionals in PHC. Referrals to a psychiatrist were few and revealed often psychiatric co-morbidity.
The prevalence of previously undiagnosed depression among women visiting GPs' drop in clinic was high. Clues for depression were identified in the depressed women's symptom presentation; they often mention mental symptoms when they visit the GP for somatic reasons e.g. respiratory infections. We suggest that GPs do selective screening for depression when women mention mental symptoms and offer to schedule a repeat visit for follow-up rather than just recommending that the patient return if the mental symptoms do not disappear.
在初级卫生保健（PHC）中，所有抑郁症患者中只有一半得到诊断。抑郁症可能长期未被发现，给护理带来高昂成本，同时患者生活质量低下。门诊是组织医疗保健的一种常见形式；然而，就诊时间较短，且侧重于解决最紧迫的问题。本研究的目的是调查在全科医生门诊就诊的女性中抑郁症的患病率和严重程度，并找出女性抑郁症的可能线索。
采用带有“高风险反馈”的两阶段筛查方法。使用贝克抑郁量表（BDI）对155名在两位全科医生门诊就诊的女性进行筛查。筛查呈阳性（BDI评分≥10）的女性由全科医生邀请再次就诊。根据《精神疾病诊断与统计手册》第四版（DSM-IV）标准诊断重度抑郁症（MDD），并使用蒙哥马利-阿斯伯格抑郁评定量表（MADRS）评估严重程度。BDI评分<10的女性组成对照组。通过问卷获取人口统计学特征。检查病历记录中首诊时提到的症状，并分为躯体症状或精神症状。
两阶段方法效果良好，在第二步即全科医生邀请女性再次就诊时退出率较低。抑郁症患病率为22.4%（95%可信区间15.6 - 29.2）。严重程度为轻度的占43%，中度的占53%，重度的占3%。与对照组（15%）相比，抑郁女性提及精神症状的频率显著更高（69%），并且有更高比例的人病假超过14天。近三分之一的抑郁女性未提及精神症状。大多数被筛查为抑郁症假阳性的女性有危机反应，需要初级卫生保健中的卫生专业人员提供进一步护理。转介给精神科医生的情况很少，且往往显示有精神共病。
在全科医生门诊就诊的女性中，先前未被诊断出的抑郁症患病率很高。在抑郁女性的症状表现中发现了抑郁症的线索；她们因躯体原因（如呼吸道感染）就诊全科医生时，往往会提及精神症状。我们建议，当女性提及精神症状时，全科医生对抑郁症进行选择性筛查，并主动安排再次就诊进行随访，而不是仅在精神症状未消失时建议患者复诊。
