Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
Med Care. 2012 Mar;50(3):227-32. doi: 10.1097/MLR.0b013e318241eb5e.
Although treatment of depression has increased in recent years, long delays commonly separate disorder onset from first treatment contact.
This study evaluates the effects of psychiatric comorbidities and sociodemographic characteristics on lifetime treatment seeking and speed to first treatment contact for major depressive disorder (MDD).
A cross-sectional epidemiological survey including retrospective structured assessments of DSM-IV MDD and other psychiatric disorders, respondent age at disorder onset, and age at first treatment contact.
A nationally representative sample of 5958 adults aged at least 18 years residing in households and group quarters who met lifetime criteria for MDD.
The percentage of respondents with lifetime MDD who reported ever seeking treatment is reported overall and stratified by sociodemographic characteristics. Unadjusted and adjusted hazard ratios (AHRs) are presented on time to first depression treatment seeking by sociodemographic characteristics and comorbid psychiatric disorders.
A majority (61.3%) of respondents with MDD reported having sought treatment for depression at some point in their lives. Time to first depression treatment contact was significantly related to the occurrence of comorbid panic disorder [AHR=2.01, 95% confidence interval (CI), 1.69-2.39], generalized anxiety disorder (AHR=1.55; 95% CI, 1.33-1.81), drug dependence (AHR=1.54; 95% CI, 1.06-2.26), dysthymic disorder (AHR=1.54; 95% CI, 1.35-1.76), and posttraumatic stress disorder (AHR=1.34; 95% CI, 1.13-1.59) and inversely related to male sex (AHR=0.74; 95% CI, 0.66-0.82) and black race/ethnicity (AHR=0.69, 95% CI, 0.59-0.81).
Comorbid psychiatric disorders, especially panic, generalized anxiety, substance use, and dysthymic disorders, appear to play an important role in accelerating treatment seeking for MDD. Outreach efforts should include a focus on depressed individuals without complicating psychiatric comorbidities.
尽管近年来抑郁症的治疗有所增加，但发病与首次治疗接触之间通常存在较长的延迟。
本研究评估了精神共病和社会人口学特征对主要抑郁症（MDD）患者寻求终生治疗和首次治疗接触的速度的影响。
这是一项横断面的流行病学调查，包括对 DSM-IV MDD 和其他精神障碍进行回顾性结构评估、障碍发病时的受访者年龄以及首次治疗接触时的年龄。
全国代表性样本为 5958 名年龄至少为 18 岁的成年人，他们居住在家庭和集体宿舍中，符合终生 MDD 标准。
报告了终生患有 MDD 的受访者中报告曾寻求治疗的比例，总体上按社会人口学特征进行分层，并按社会人口学特征和共患精神障碍报告了首次寻求抑郁治疗的时间的未调整和调整后的风险比（AHR）。
大多数（61.3%）患有 MDD 的受访者报告曾在其一生中的某个时间寻求过抑郁症治疗。首次抑郁治疗接触的时间与共患惊恐障碍[AHR=2.01，95%置信区间（CI），1.69-2.39]、广泛性焦虑障碍（AHR=1.55；95%CI，1.33-1.81）、药物依赖（AHR=1.54；95%CI，1.06-2.26）、心境恶劣障碍（AHR=1.54；95%CI，1.35-1.76）和创伤后应激障碍（AHR=1.34；95%CI，1.13-1.59）显著相关，而与男性性别（AHR=0.74；95%CI，0.66-0.82）和黑人种族/民族（AHR=0.69，95%CI，0.59-0.81）呈负相关。
精神共病，尤其是惊恐、广泛性焦虑、物质使用和心境恶劣障碍，似乎在加速 MDD 的治疗寻求方面发挥了重要作用。外展工作应重点关注没有复杂精神共病的抑郁患者。
