Research Department of Primary Care & Population Health, Hampstead Campus, University College London, London, UK.
Br J Psychiatry. 2011 Jun;198(6):472-8. doi: 10.1192/bjp.bp.110.085092.
Mixed anxiety and depressive disorder (MADD) is common yet ill-defined, with little known about outcomes.
To determine MADD outcomes over 1 year.
We recruited 250 adults attending seven London general practices with mild-moderate distress. Three groups were defined using a diagnostic interview: MADD, other ICD-10 psychiatric diagnosis, no psychiatric diagnosis. We assessed symptoms of distress (General Health Questionnaire-28), quality of life (12-item Short Form Health Survey), general practitioner (GP) diagnosis and consultation rate at baseline, 3 months and 1 year.
Two-thirds of participants with MADD had no significant psychological distress at 3 months (61%) or 1 year (69%). However, compared with those with no diagnosis, individuals had twice the risk of significant distress (incidence rate ratio 2.39, 95% CI 1.29-4.42) at 3 months but not 1 year, and persistently lower quality of life (mental health functioning). There was no significant difference in GP consultation rate/diagnosis.
The majority with MADD improved, but individuals had an increased risk of significant distress at 3 months and a lower quality of life. As we cannot currently predict those with a poorer prognosis these patients should be actively monitored in primary care.
混合焦虑和抑郁障碍（MADD）较为常见但定义不明确，其结局鲜为人知。
确定 MADD 在 1 年内的结局。
我们招募了 250 名在伦敦 7 家普通诊所就诊的、有轻度至中度困扰的成年人。使用诊断性访谈将他们分为 3 组：MADD、其他 ICD-10 精神诊断、无精神诊断。我们在基线、3 个月和 1 年时评估了困扰症状（一般健康问卷-28）、生活质量（12 项简短健康调查问卷）、全科医生（GP）诊断和就诊率。
三分之二的 MADD 患者在 3 个月（61%）或 1 年（69%）时没有明显的心理困扰。然而，与无诊断的患者相比，在 3 个月时有显著困扰的个体风险增加了两倍（发病率比 2.39，95%CI 1.29-4.42），但在 1 年时没有，且生活质量（心理健康功能）持续较低。GP 就诊率/诊断率没有显著差异。
大多数 MADD 患者情况有所改善，但在 3 个月时有更高的显著困扰风险和较低的生活质量。由于我们目前无法预测预后较差的患者，这些患者应在初级保健中得到积极监测。
