Demyttenaere Koen, Verhaeghen Anne, Dantchev Nicolas, Grassi Luigi, Montejo Angel L, Perahia David G S, Quail Deborah, Reed Catherine, Tylee Andre, Bauer Michael
University Hospitals Gasthuisberg and University Psychiatric Centre KuLeuven, campus Leuven, Belgium.
Prim Care Companion J Clin Psychiatry. 2009;11(6):307-15. doi: 10.4088/PCC.08m00748blu.
To examine the diagnostic status of patients enrolled in the Factors Influencing Depression Endpoints Research (FINDER) study and symptomatic outcomes and baseline characteristics associated with remission 6 months after commencing antidepressant therapy.
Status of clinically diagnosed depressed patients was based on self-rated Hospital Anxiety and Depression Scale (HADS) scores. Five diagnostic categories were defined: noncaseness, mixed anxiety-depression (subthreshold depressive and anxious symptomatology), caseness for depression, caseness for anxiety, and caseness for comorbid anxiety-depression. Assessments included the Somatic Symptom Inventory and health-related quality of life (HRQoL) using the Medical Outcomes Study 36-item Short-Form Health Survey. Remission rates (based on HADS noncaseness for both depression and anxiety) and their associations with baseline characteristics were investigated. Patients were enrolled between May 2004 and September 2005.
Of the 3,353 patients enrolled, 66.4% met the HADS criteria for probable depressive disorder and 74.1% met the HADS criteria for probable anxiety disorder. Somatic symptom severity (painful and nonpainful) was highest and HRQoL was lowest in the comorbid anxiety-depression group. After 6 months, remission rates were 50.2% for caseness for depression, 40.4% for caseness for anxiety, and 40.6% for caseness for comorbid anxiety-depression. A lower number of previous depressive episodes, shorter current episode duration, lower painful and nonpainful somatic symptom scores, being married, a higher educational level, and working for pay were most consistently associated with higher remission rates.
Physicians do not always differentiate between anxiety and depressive symptoms when making a clinical diagnosis of depression. At baseline, most enrolled patients had significant emotional depressive and anxious symptoms, as well as significant nonpainful and painful somatic symptomatology, and these factors were associated with outcome.
研究参与抑郁终点影响因素研究（FINDER）的患者的诊断状况，以及开始抗抑郁治疗6个月后与缓解相关的症状性结局和基线特征。
临床诊断为抑郁症患者的状况基于自评医院焦虑抑郁量表（HADS）评分。定义了五个诊断类别：非病例、混合性焦虑抑郁（亚阈值抑郁和焦虑症状）、抑郁症病例、焦虑症病例以及共病焦虑抑郁病例。评估包括使用医学结局研究36项简短健康调查的躯体症状量表和健康相关生活质量（HRQoL）。研究缓解率（基于HADS抑郁和焦虑均为非病例）及其与基线特征的关联。患者于2004年5月至2005年9月入组。
在入组的3353例患者中，66.4%符合HADS可能的抑郁症标准，74.1%符合HADS可能的焦虑症标准。共病焦虑抑郁组的躯体症状严重程度（疼痛和非疼痛）最高，健康相关生活质量最低。6个月后，抑郁症病例的缓解率为50.2%，焦虑症病例为40.4%，共病焦虑抑郁病例为40.6%。既往抑郁发作次数较少、当前发作持续时间较短、疼痛和非疼痛躯体症状评分较低、已婚、教育水平较高以及有工作收入与较高的缓解率最一致相关。
医生在对抑郁症进行临床诊断时并不总是能区分焦虑和抑郁症状。在基线时，大多数入组患者有明显的情绪抑郁和焦虑症状，以及明显的非疼痛和疼痛躯体症状，这些因素与结局相关。
