Riihimäki K, Sintonen H, Vuorilehto M, Jylhä P, Saarni S, Isometsä E
Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland; Department of Psychiatry, Health Care and Social Services, P.O. Box 41, 04401 Järvenpää, Finland.
Department of Public Health, University of Helsinki, P.O. Box 20, 00014 Helsinki, Finland.
Eur Psychiatry. 2016 Sep;37:28-34. doi: 10.1016/j.eurpsy.2016.04.008. Epub 2016 Jul 18.
Depressive disorders are known to impair health-related quality of life (HRQoL) both in the short and long term. However, the determinants of long-term HRQoL outcomes in primary care patients with depressive disorders remain unclear.
In a primary care cohort study of patients with depressive disorders, 82% of 137 patients were prospectively followed up for five years. Psychiatric disorders were diagnosed with SCID-I/P and SCID-II interviews; clinical, psychosocial and socio-economic factors were investigated by rating scales and questionnaires plus medical and psychiatric records. HRQoL was measured with the generic 15D instrument at baseline and five years, and compared with an age-standardized general population sample (n=3707) at five years.
Depression affected the 15D total score and almost all dimensions at both time points. At the end of follow-up, HRQoL of patients in major depressive episode (MDE) was particularly low, and the association between severity of depression (Beck Depression Inventory [BDI]) and HRQoL was very strong (r=-0.804). The most significant predictors for change in HRQoL were changes in BDI and Beck Anxiety Inventory (BAI) scores. The mean 15D score of depressive primary care patients at five years was much worse than in the age-standardized general population, reaching normal range only among patients who were in clinical remission and had virtually no symptoms.
Among depressive primary care patients, presence of current depressive symptoms markedly reduces HRQoL, with symptoms of concurrent anxiety also having a marked impact. For HRQoL to normalize, current depressive and anxiety symptoms must be virtually absent.
已知抑郁障碍在短期和长期都会损害健康相关生活质量（HRQoL）。然而，原发性护理中抑郁障碍患者长期HRQoL结果的决定因素仍不清楚。
在一项针对抑郁障碍患者的初级护理队列研究中，137名患者中的82%接受了为期五年的前瞻性随访。使用SCID-I/P和SCID-II访谈诊断精神障碍；通过评定量表、问卷以及医疗和精神科记录调查临床、心理社会和社会经济因素。在基线和五年时使用通用的15D工具测量HRQoL，并在五年时与年龄标准化的普通人群样本（n = 3707）进行比较。
抑郁在两个时间点均影响15D总分及几乎所有维度。随访结束时，重度抑郁发作（MDE）患者的HRQoL特别低，抑郁严重程度（贝克抑郁量表[BDI]）与HRQoL之间的关联非常强（r = -0.804）。HRQoL变化的最显著预测因素是BDI和贝克焦虑量表（BAI）评分的变化。抑郁初级护理患者五年时的平均15D评分比年龄标准化的普通人群差得多，仅在临床缓解且几乎没有症状的患者中达到正常范围。
在抑郁初级护理患者中，当前抑郁症状的存在显著降低HRQoL，同时存在的焦虑症状也有显著影响。为使HRQoL正常化，必须几乎不存在当前的抑郁和焦虑症状。
