Lotfi Louise, Flyckt Lena, Krakau Ingvar, Mårtensson Björn, Nilsson Gunnar H
Department of Neurobiology, Care Science and Society, Centre for Family and Community Medicine, Karolinska Institutet, Stockholm, Sweden.
Nord J Psychiatry. 2010 Dec;64(6):421-7. doi: 10.3109/08039481003786378. Epub 2010 Apr 29.
Depression often remains undetected in primary healthcare, and a two-stage screening procedure has been recommended for future research on the recognition, management and outcome of these patients. The aim of this study was to analyse the occurrence and the severity of depression, as well as gender, age and psychiatric co-morbidity in patients with previously undetected depression using a screening questionnaire followed by a diagnostic interview for detecting depression among patients visiting primary healthcare.
All patients visiting a primary healthcare centre during a period of 10 days were asked to fill in the self-rating version of the Montgomery-Åsberg Depression Rating Scale. Patients with a score of 12 or more were invited to participate in a structured diagnostic interview based on the Primary Care Evaluation of Mental Disorders.
Out of 221 (=N) participants, 45 (20.4%) patients showed signs of depression (scores of 12 or more). Of these 45 patients, 31 consented to the structured interview, and of those, 28 (12.7%) fulfilled the criteria for depression, 17 (7.7%) had a major depression and 11 (5.0%) had a mixed depression-anxiety condition.
The rate of undetected depression in primary healthcare was considerable. The majority of these patients had a major depression. Psychiatric co-morbidity among depressed patients was almost universal. The two-stage procedure of opportunistic screening with the Montgomery-Åsberg Depression Rating Scale and the Primary Care Evaluation of Mental Disorders seems to be a feasible method for detecting these patients in primary healthcare.
在初级医疗保健中，抑郁症常常未被发现，因此推荐采用两阶段筛查程序用于未来对这些患者的识别、管理及预后的研究。本研究的目的是通过使用筛查问卷，随后对前来初级医疗保健机构就诊的患者进行抑郁症诊断访谈，分析此前未被发现的抑郁症患者中抑郁症的发生率、严重程度以及性别、年龄和精神共病情况。
要求在10天内前往初级医疗保健中心就诊的所有患者填写蒙哥马利-阿斯伯格抑郁量表自评版。得分12分及以上的患者被邀请参加基于精神障碍初级保健评估的结构化诊断访谈。
在221名（=N）参与者中，45名（20.4%）患者表现出抑郁迹象（得分12分及以上）。在这45名患者中，31名同意参加结构化访谈，其中28名（12.7%）符合抑郁症标准，17名（7.7%）患有重度抑郁症，11名（5.0%）患有抑郁-焦虑混合症。
初级医疗保健中未被发现的抑郁症发生率相当高。这些患者中的大多数患有重度抑郁症。抑郁症患者中的精神共病几乎普遍存在。使用蒙哥马利-阿斯伯格抑郁量表和精神障碍初级保健评估进行机会性筛查的两阶段程序似乎是在初级医疗保健中检测这些患者的一种可行方法。
