DeJean D, Giacomini M, Vanstone M, Brundisini F
Ont Health Technol Assess Ser. 2013 Sep 1;13(16):1-33. eCollection 2013.
Depression and anxiety are highly prevalent in patients with chronic disease, but remain undertreated despite significant negative consequences on patient health. A number of clinical groups have developed recommendations for depression screening practices in the chronic disease population.
The objective of this analysis was to review empirical qualitative research on the experiences of patients with chronic disease (e.g., COPD, diabetes, heart disease, stroke) and comorbid depression or anxiety, and to highlight the implications of the screening and management of anxiety and/or depression on chronic disease outcomes.
We performed literature searches for studies published from January 2002 to May 2012. We applied a qualitative mega-filter to nine condition-specific search filters. Titles and abstracts were reviewed by two reviewers and, for the studies that met the eligibility criteria, full-text articles were obtained. Qualitative meta-synthesis was used to integrate findings across relevant published primary research studies. Qualitative meta-synthesis produced a synthesis of evidence that both retained the original meaning of the authors and offered a new, integrative interpretation of the phenomenon through a process of comparing and contrasting findings across studies.
The findings of 20 primary qualitative studies were synthesized. Patients tended to experience their chronic conditions and anxiety or depression as either independent or inter-related (i.e., the chronic disease lead to depression/anxiety, the depression/anxiety lead to the chronic disease, or the two conditions exacerbated each other). Potential barriers to screening for depression or anxiety were also identified.
A wider array of issues might have been captured if the analysis had focused on broader psychological responses to the chronic disease experience. However, given the objective to highlight implications for screening for anxiety or depression, the more narrow focus seemed most relevant.
Chronic disease and anxiety or depression can be independent or inter-related. Patients may be reluctant to acknowledge depression or anxiety as a separate condition, or may not recognize that the conditions are separate because of overlapping physical symptoms. More qualitative research is needed to specifically address screening for depression or anxiety.
Depression is a common complication of chronic disease. It may worsen the disease, and it may also affect the self-management of the disease. Screening for depression earlier, and then treating it, may reduce distress and improve symptoms of the chronic disease, leading to better quality of life.
抑郁症和焦虑症在慢性病患者中极为常见，尽管对患者健康会产生严重负面影响，但仍未得到充分治疗。一些临床组织已针对慢性病患者群体的抑郁症筛查实践制定了建议。
本分析的目的是回顾关于慢性病（如慢性阻塞性肺疾病、糖尿病、心脏病、中风）患者合并抑郁症或焦虑症经历的实证性定性研究，并强调焦虑症和/或抑郁症的筛查与管理对慢性病治疗结果的影响。
我们对2002年1月至2012年5月发表的研究进行了文献检索。我们对九个特定疾病的搜索过滤器应用了定性超级过滤器。两名评审员对标题和摘要进行了审查，对于符合纳入标准的研究，获取了全文。采用定性元综合法整合相关已发表的原发性研究的结果。定性元综合法产生了一种证据综合，既保留了作者的原意，又通过对各项研究结果进行比较和对比的过程，对该现象提供了一种新的、综合性的解释。
综合了20项原发性定性研究的结果。患者倾向于将其慢性病与焦虑症或抑郁症视为相互独立或相互关联的（即慢性病导致抑郁/焦虑，抑郁/焦虑导致慢性病，或两种情况相互加剧）。还确定了抑郁症或焦虑症筛查的潜在障碍。
如果分析关注对慢性病经历更广泛的心理反应，可能会涵盖更广泛的问题。然而，鉴于旨在强调焦虑症或抑郁症筛查的影响，更狭窄的关注点似乎最为相关。
慢性病与焦虑症或抑郁症可能相互独立或相互关联。患者可能不愿承认抑郁症或焦虑症是一种单独的病症，或者可能由于身体症状重叠而未认识到这些病症是分开的。需要更多的定性研究来专门解决抑郁症或焦虑症的筛查问题。
抑郁症是慢性病的常见并发症。它可能会使病情恶化，也可能影响疾病的自我管理。尽早筛查抑郁症并进行治疗，可能会减轻痛苦，改善慢性病症状，从而提高生活质量。
