Carvalho André F, Nunes-Neto Paulo R, Castelo Milena S, Macêdo Danielle S, Dimellis Dimos, Soeiro-de-Souza Márcio G, Soczynska Joanna K, McIntyre Roger S, Hyphantis Thomas N, Fountoulakis Konstantinos N
Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil; Department of Clinical Medicine, Faculty of Medicine, Fortaleza, Ceará, Brazil.
Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil.
J Affect Disord. 2014 Jun;162:120-7. doi: 10.1016/j.jad.2014.03.040. Epub 2014 Mar 30.
To compare individuals in primary care (PC) who screen positive for bipolar depression to those who screened positive for unipolar depression on mental health care ouctomes, PC service utilization, medical comorbidities, suicidal ideation, health-related quality of life (HRQoL) and psychosocial functioning.
In this cross-sectional study, participants (N=1197) answered self-reported measures of depressive symptoms (Center for epidemiologic studies depression scale), HRQoL (World Health Organization Quality of Life instrument-Abbreviated version), medical comorbidity (functional comorbidity index) and functioning (Functional Assessment Short test). Participants were partitioned into 'bipolar' and 'unipolar' depression groups based on a predefined cutoff on the Brazilian mood disorder questionnaire.
The prevalence of bipolar depression was in PC was 4.6% (95% CI: 3.4-5.8). Participants with bipolar depression were more likely to endorse suicidal ideation, present with more medical comorbidities, report a worse physical HRQoL and have a higher rate of PC services utilization as compared to participants who screened positive for unipolar depression. Only six (10.9%) participants were recognized by the general practitioner as having a diagnosis of bipolar depression.
The cross-sectional design prevents firm causal inferences from being drawn. A positive screen for BD does not substantiate the actual diagnosis. Co-morbid mental disorders were not accessed.
Bipolar depression is common and under-recognized in Brazilian PC services. A positive screen for bipolar depression was associated with worse clinical outcomes and greater PC service utilization.
比较在初级保健（PC）中双相抑郁筛查呈阳性的个体与单相抑郁筛查呈阳性的个体在精神卫生保健结果、PC服务利用情况、合并症、自杀意念、健康相关生活质量（HRQoL）和心理社会功能方面的差异。
在这项横断面研究中，参与者（N = 1197）回答了关于抑郁症状（流行病学研究中心抑郁量表）、HRQoL（世界卫生组织生活质量量表简版）、合并症（功能合并症指数）和功能（功能评估简短测试）的自我报告测量。根据巴西情绪障碍问卷上预先设定的临界值，将参与者分为“双相”和“单相”抑郁组。
PC中双相抑郁的患病率为4.6%（95%可信区间：3.4 - 5.8）。与单相抑郁筛查呈阳性的参与者相比，双相抑郁的参与者更有可能认可自杀意念，有更多的合并症，报告身体HRQoL更差，且PC服务利用率更高。只有6名（10.9%）参与者被全科医生诊断为双相抑郁。
横断面设计无法得出确凿的因果推断。BD筛查呈阳性并不能证实实际诊断。未评估共病的精神障碍。
双相抑郁在巴西的PC服务中很常见且未得到充分认识。双相抑郁筛查呈阳性与更差的临床结果和更高的PC服务利用率相关。
