Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA,
J Gen Intern Med. 2013 Dec;28(12):1637-42. doi: 10.1007/s11606-013-2541-y. Epub 2013 Jul 30.
Arthritis affects 20 % of the adult US population and is associated with comorbid depression. Depression screening guidelines have been endorsed for high-risk groups, including persons with arthritis, in the hopes that screening will increase recognition and use of appropriate interventions.
To examine national rates of depression and depression screening for patients with arthritis between 2006 and 2010.
We used nationally representative cross-sections of ambulatory visits in the United States from the National Ambulatory Medical Care Survey from 2006 to 2010, which included 18,507 visits with a diagnosis of arthritis. When weighted to the US population, this total represents approximately 644 million visits.
Visits where arthritis was listed among diagnoses. Outcomes were survey-weighted estimates of depression and prevalence of depression screening among patients with arthritis across patient and physician characteristics.
Of the 644,419,374 visits with arthritis listed, 83,574,127 (13 %) were associated with a comorbid diagnosis of depression. The odds ratio for comorbid depression with arthritis was 1.42 (95 % CI 1.3, 1.5). Depression screening occurred at 3,835,000 (1 %) visits associated with arthritis. When examining the rates of depression screening between ambulatory visits with and without arthritis listed, there was no difference in depression screening rates; both were approximately 1 %. There was no difference in screening rates by provider type. Compared to visits with other common, chronic conditions, the prevalence of depression at arthritis visits was high (13 per 100 visits), although the prevalence of depression screening at arthritis visits was low (0.68 per 100 visits).
Despite the high prevalence of depression with arthritis, screening for depression was performed at few arthritis visits, representing missed opportunities to detect a common, serious comorbidity. Improved depression screening by providers would identify affected patients, and may lead to appropriate interventions such as mental health referrals and/or treatment with anti-depressants.
关节炎影响了美国 20%的成年人口，且与共病性抑郁相关。为了提高对关节炎患者等高危人群的识别和适当干预的意识，已经为其制定了抑郁筛查指南。
检查 2006 年至 2010 年期间关节炎患者的抑郁发生率和抑郁筛查率。
我们使用了美国国家门诊医疗调查（National Ambulatory Medical Care Survey）2006 年至 2010 年期间的全国门诊就诊横断面数据，其中包括 18507 例关节炎诊断的就诊。经过加权处理后，这一总数代表了大约 6.44 亿次就诊。
列出关节炎的就诊。根据患者和医生的特征，将关节炎患者的抑郁发生率和抑郁筛查率作为调查加权估计值。
在列出的 644419374 次关节炎就诊中，有 83574127（13%）次与共病性抑郁诊断相关。关节炎共病抑郁的比值比为 1.42（95%CI 1.3，1.5）。在与关节炎相关的 383.5 万（1%）次就诊中进行了抑郁筛查。在检查列出关节炎和未列出关节炎的门诊就诊之间的抑郁筛查率时，两者的筛查率没有差异；均约为 1%。不同类型的提供者之间筛查率没有差异。与其他常见慢性疾病的就诊相比，关节炎就诊时的抑郁发生率较高（每 100 次就诊中有 13 例），但关节炎就诊时的抑郁筛查率较低（每 100 次就诊中有 0.68 次）。
尽管关节炎患者的抑郁发生率较高，但在很少的关节炎就诊中进行了抑郁筛查，这表明错过了发现常见严重共病的机会。提供者改善抑郁筛查可以识别受影响的患者，并可能导致适当的干预，如心理健康转介和/或使用抗抑郁药物治疗。
