General Practice and Primary Health Care Academic Centre, The University of Melbourne, Carlton, Australia.
Ann Fam Med. 2014 Jan-Feb;12(1):57-65. doi: 10.1370/afm.1562.
Indicators of prognosis should be considered to fully inform clinical decision making in the treatment of depression. This study examines whether self-rated health predicts long-term depression outcomes in primary care.
Our analysis was based on the first 5 years of a prospective 10-year cohort study underway since January 2005 conducted in 30 randomly selected Australian primary care practices. Participants were 789 adult patients with a history of depressive symptoms. Main outcome measures include risks, risk differences, and risk ratios of major depressive syndrome (MDS) on the Patient Health Questionnaire.
Retention rates during the 5 years were 660 (84%), 586 (74%), 560 (71%), 533 (68%), and 517 (66%). At baseline, MDS was present in 27% (95% CI, 23%-30%). Cross-sectional analysis of baseline data showed participants reporting poor or fair self-rated health had greater odds of chronic illness, MDS, and lower socioeconomic status than those reporting good to excellent self-rated health. For participants rating their health as poor to fair compared with those rating it good to excellent, risk ratios of MDS were 2.10 (95% CI, 1.60-2.76), 2.38 (95% CI, 1.77-3.20), 2.22 (95% CI, 1.70-2.89), 1.73 (95% CI, 1.30-2.28), and 2.15 (95% CI, 1.59-2.90) at 1, 2, 3, 4, and 5 years, after accounting for missing data using multiple imputation. After adjusting for age, sex, multimorbidity, and depression status and severity, self-rated health remained a predictor of MDS up to 5 years.
Self-rated health offers family physicians an efficient and simple way to identify patients at risk of poor long-term depression outcomes and to inform therapeutic decision making.
预后指标应被考虑用于充分告知抑郁症治疗中的临床决策。本研究旨在检验自评健康是否能预测初级保健中抑郁的长期结局。
我们的分析基于一项自 2005 年 1 月以来开展的前瞻性 10 年队列研究的前 5 年，该研究在 30 个随机选择的澳大利亚初级保健实践中进行。参与者为 789 名有抑郁症状病史的成年患者。主要结局测量包括患者健康问卷中的主要抑郁综合征 (MDS) 的风险、风险差异和风险比。
在 5 年内的保留率分别为 660（84%）、586（74%）、560（71%）、533（68%）和 517（66%）。基线时，MDS 的发生率为 27%（95%CI，23%-30%）。基线数据的横断面分析显示，报告健康状况差或一般的参与者比报告健康状况良好至优秀的参与者更有可能患有慢性疾病、MDS 和较低的社会经济地位。与自评健康状况良好至优秀的参与者相比，自评健康状况差或一般的参与者的 MDS 风险比分别为 2.10（95%CI，1.60-2.76）、2.38（95%CI，1.77-3.20）、2.22（95%CI，1.70-2.89）、1.73（95%CI，1.30-2.28）和 2.15（95%CI，1.59-2.90），在考虑使用多重插补处理缺失数据后，分别在 1、2、3、4 和 5 年时。在调整年龄、性别、多种合并症和抑郁状态和严重程度后，自评健康仍然是 MDS 的预测因素，最长可达 5 年。
自评健康为家庭医生提供了一种有效且简单的方法，可以识别出有不良长期抑郁结局风险的患者，并为治疗决策提供信息。
