Department of Family Practice and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, Netherlands.
J Geriatr Psychiatry Neurol. 2011 Jun;24(2):98-107. doi: 10.1177/0891988711405332.
Dizzy patients with both psychological and physical symptoms tend to have high levels of disability and are at risk of remaining symptomatic and disabled. The objective of this study was to develop a prediction model for the presence of anxiety and/or depression in older dizzy patients in primary care.
We performed a cross-sectional study among 415 older patients consulting their primary care physician for persistent dizziness. Participants underwent a standardized, comprehensive evaluation and completed self-administered questionnaires regarding anxiety and depression (PRIME-MD Patient Health Questionnaire [PHQ]) and dizziness-related disability (Dizziness Handicap Inventory). To determine the diagnostic indicators of anxiety and/or depression, we used multiple logistic regression analysis with ''presence of Panic Disorder, Other Anxiety Disorder, or Major Depressive Disorder'' as dependent variable. Potential diagnostic indicators included dizziness-related disability, patient characteristics (age, sex, history of anxiety, and history of depression), and dizziness characteristics (description of dizziness, provoking circumstances, associated symptoms, onset, frequency, duration, and avoidance of activities because of dizziness).
According to the PHQ, an anxiety and/or depressive disorder was present in 90 patients (22%), of whom 35 reported no medical history of anxiety or depression, nor current pharmacological treatment for these disorders. In the final model, dizziness-related disability, a history of depression, and accompanying fear were associated with an increased odd of anxiety and/or depression, whereas tinnitus and rotational dizziness were associated with a decreased odd of anxiety and/or depression. The model showed good calibration (Hosmer-Lemeshow P value of .46) and discrimination (adjusted area under the receiver operating characteristic curve [AUC] after bootstrapping of .82).
Primary care physicians should consider the existence of anxiety and depression in older patients presenting with dizziness. After external validation, our model may contribute to better recognition and hence better management of anxiety and depression in older patients with dizziness in primary care.
同时存在心理和身体症状的头晕患者往往残疾程度较高，并有持续出现症状和残疾的风险。本研究的目的是为初级保健中老年头晕患者中焦虑和/或抑郁的存在建立预测模型。
我们对 415 名因持续性头晕而向初级保健医生就诊的老年患者进行了横断面研究。参与者接受了标准化的全面评估，并完成了焦虑和抑郁（PRIME-MD 患者健康问卷[PHQ]）以及与头晕相关的残疾（头晕障碍问卷）的自我管理问卷。为了确定焦虑和/或抑郁的诊断指标，我们使用多元逻辑回归分析，将“惊恐障碍、其他焦虑障碍或重度抑郁障碍的存在”作为因变量。潜在的诊断指标包括与头晕相关的残疾、患者特征（年龄、性别、焦虑病史和抑郁病史）以及头晕特征（头晕描述、诱发情况、伴随症状、发病、频率、持续时间和因头晕而避免活动）。
根据 PHQ，90 名患者（22%）存在焦虑和/或抑郁障碍，其中 35 名患者既无焦虑或抑郁病史，也无当前用于治疗这些疾病的药物。在最终模型中，与头晕相关的残疾、抑郁病史和伴随的恐惧与焦虑和/或抑郁的患病几率增加相关，而耳鸣和旋转性头晕与焦虑和/或抑郁的患病几率降低相关。该模型具有良好的校准度（Hosmer-Lemeshow P 值为.46）和区分度（Bootstrapping 后调整的接受者操作特征曲线下面积[AUC]为.82）。
初级保健医生应考虑头晕就诊的老年患者中是否存在焦虑和抑郁。经过外部验证后，我们的模型可能有助于更好地识别和管理初级保健中老年头晕患者的焦虑和抑郁。
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