Katon Wayne J
Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington 98195-6560, USA.
Dialogues Clin Neurosci. 2011;13(1):7-23. doi: 10.31887/DCNS.2011.13.1/wkaton.
There is a bidirectional relationship between depression and chronic medical disorders. The adverse health risk behaviors and psychobiological changes associated with depression increase the risk for chronic medical disorders, and biological changes and complications associated with chronic medical disorders may precipitate depressive episodes. Comorbid depression is associated with increased medical symptom burden, functional impairment, medical costs, poor adherence to self-care regimens, and increased risk of morbidity and mortality in patients with chronic medical disorders. Depression may worsen the course of medical disorders because of its effect on proinflammatory factors, hypothalamic-pituitary axis, autonomic nervous system, and metabolic factors, in addition to being associated with a higher risk of obesity, sedentary lifestyle, smoking, and poor adherence to medical regimens. Both evidence-based psychotherapies and antidepressant medication are efficacious treatments for depression. Collaborative depression care has been shown to be an effective way to deliver these treatments to large primary care populations with depression and chronic medical illness.
抑郁症与慢性躯体疾病之间存在双向关系。与抑郁症相关的不良健康风险行为和心理生物学变化会增加患慢性躯体疾病的风险，而与慢性躯体疾病相关的生物学变化和并发症可能会引发抑郁发作。共病性抑郁症与慢性躯体疾病患者的医疗症状负担加重、功能损害、医疗费用增加、对自我护理方案的依从性差以及发病和死亡风险增加有关。抑郁症可能会因对促炎因子、下丘脑 - 垂体轴、自主神经系统和代谢因子的影响而使躯体疾病的病程恶化，此外还与肥胖、久坐不动的生活方式、吸烟以及对医疗方案的依从性差的较高风险相关。循证心理治疗和抗抑郁药物都是治疗抑郁症的有效方法。协作式抑郁症护理已被证明是一种向患有抑郁症和慢性躯体疾病的大量初级保健人群提供这些治疗的有效方式。
