Koyanagi A, Oh H, Stubbs B, Haro J M, DeVylder J E
Parc Sanitari Sant Joan de Déu,Universitat de Barcelona,Fundació Sant Joan de Déu,Barcelona,Spain.
University of California Berkeley School of Public Health,Berkeley,CA,USA.
Psychol Med. 2017 Feb;47(3):531-542. doi: 10.1017/S0033291716002750. Epub 2016 Oct 27.
The co-existence of depression and psychotic experiences (PEs) is associated with more pronounced adverse health outcomes compared to depression alone. However, data on its prevalence and correlates are lacking in the general adult population, and there is no published data on its association with chronic physical conditions.
Cross-sectional, community-based data from 201 337 adults aged ⩾18 years from 47 low- and middle-income countries from the World Health Survey were analyzed. The presence of past 12-month PE and DSM-IV depression was assessed with the Composite International Diagnostic Interview (CIDI). Information on six chronic medical conditions (chronic back pain, edentulism, arthritis, angina, asthma, diabetes) were obtained by self-report. Multivariable logistic regression analysis was performed.
The crude overall prevalence of co-morbid depression/PEs was 2.5% [95% confidence interval (CI) 2.3-2.7%], with the age- and sex-adjusted prevalence ranging from 0.1% (Sri Lanka, Vietnam) to 9.03% (Brazil). Younger age, urban setting, current smoking, alcohol consumption, and anxiety were significant correlates of co-existing depression/PEs. Co-occurring depression/PEs was associated with significantly higher odds for arthritis, angina, and diabetes beyond that of depression alone after adjusting for sociodemographics, anxiety, and country, with odds ratios (depression/PEs v. depression only) being: arthritis 1.30 (95% CI 1.07-1.59, p = 0.0086); angina 1.40 (95% CI 1.18-1.67, p = 0.0002); diabetes 1.65 (95% CI 1.21-2.26, p = 0.0017).
The prevalence of co-existing depression/PEs was non-negligible in most countries. Our study suggests that when depression/PE or a chronic condition (e.g. arthritis, angina, diabetes) is detected, screening for the other may be important to improve clinical outcomes.
与单纯抑郁症相比，抑郁症与精神病性体验（PEs）并存与更明显的不良健康后果相关。然而，普通成年人群中关于其患病率及相关因素的数据尚缺乏，且关于其与慢性身体疾病关联的公开数据也不存在。
分析了来自世界卫生调查中47个低收入和中等收入国家的201337名18岁及以上成年人的基于社区的横断面数据。采用复合国际诊断访谈（CIDI）评估过去12个月内PEs和DSM-IV抑郁症的存在情况。通过自我报告获取六种慢性疾病（慢性背痛、无牙、关节炎、心绞痛、哮喘、糖尿病）的信息。进行多变量逻辑回归分析。
共病抑郁症/PEs的总体粗患病率为2.5%[95%置信区间（CI）2.3 - 2.7%]，年龄和性别调整后的患病率范围从0.1%（斯里兰卡、越南）至9.03%（巴西）。较年轻的年龄、城市环境、当前吸烟、饮酒和焦虑是并存抑郁症/PEs的显著相关因素。在调整社会人口统计学、焦虑和国家因素后，并存的抑郁症/PEs与关节炎、心绞痛和糖尿病的患病几率显著高于单纯抑郁症，优势比（抑郁症/PEs对比仅抑郁症）分别为：关节炎1.30（95%CI 1.07 - 1.59，p = 0.0086）；心绞痛1.40（95%CI 1.18 - 1.67，p = 0.0002）；糖尿病1.65（95%CI 1.21 - 2.26，p = 0.0017）。
在大多数国家，并存抑郁症/PEs的患病率不可忽视。我们的研究表明，当检测到抑郁症/PEs或慢性疾病（如关节炎、心绞痛、糖尿病）时，筛查另一种情况可能对改善临床结局很重要。
