重度抑郁症患者需要高度专业化护理的指标：一项系统综述。
Indicators of patients with major depressive disorder in need of highly specialized care: A systematic review.
作者信息
van Krugten Frédérique C W, Kaddouri Meriam, Goorden Maartje, van Balkom Anton J L M, Bockting Claudi L H, Peeters Frenk P M L, Hakkaart-van Roijen Leona
机构信息
Institute of Health Policy & Management and Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands.
Department of Psychiatry and EMGO Institute for Health and Care Research, VU-University Medical Center and GGZ inGeest, Amsterdam, The Netherlands.
出版信息
PLoS One. 2017 Feb 8;12(2):e0171659. doi: 10.1371/journal.pone.0171659. eCollection 2017.
OBJECTIVES
Early identification of patients with major depressive disorder (MDD) that cannot be managed by secondary mental health services and who require highly specialized mental healthcare could enhance need-based patient stratification. This, in turn, may reduce the number of treatment steps needed to achieve and sustain an adequate treatment response. The development of a valid tool to identify patients with MDD in need of highly specialized care is hampered by the lack of a comprehensive understanding of indicators that distinguish patients with and without a need for highly specialized MDD care. The aim of this study, therefore, was to systematically review studies on indicators of patients with MDD likely in need of highly specialized care.
METHODS
A structured literature search was performed on the PubMed and PsycINFO databases following PRISMA guidelines. Two reviewers independently assessed study eligibility and determined the quality of the identified studies. Three reviewers independently executed data extraction by using a pre-piloted, standardized extraction form. The resulting indicators were grouped by topical similarity, creating a concise summary of the findings.
RESULTS
The systematic search of all databases yielded a total of 7,360 references, of which sixteen were eligible for inclusion. The sixteen papers yielded a total of 48 unique indicators. Overall, a more pronounced depression severity, a younger age of onset, a history of prior poor treatment response, psychiatric comorbidity, somatic comorbidity, childhood trauma, psychosocial impairment, older age, and a socioeconomically disadvantaged status were found to be associated with proxies of need for highly specialized MDD care.
CONCLUSIONS
Several indicators are associated with the need for highly specialized MDD care. These indicators provide easily measurable factors that may serve as a starting point for the development of a valid tool to identify patients with MDD in need of highly specialized care.
目的
早期识别出无法由二级心理健康服务机构管理、需要高度专业化心理保健的重度抑郁症（MDD）患者，有助于加强基于需求的患者分层。这反过来可能会减少实现并维持充分治疗反应所需的治疗步骤数量。由于缺乏对区分需要和不需要高度专业化MDD护理患者的指标的全面理解，开发一种有效的工具来识别需要高度专业化护理的MDD患者受到了阻碍。因此，本研究的目的是系统回顾关于可能需要高度专业化护理的MDD患者指标的研究。
方法
按照PRISMA指南在PubMed和PsycINFO数据库上进行结构化文献检索。两名评审员独立评估研究的 eligibility 并确定所识别研究的质量。三名评审员使用预先试点的标准化提取表独立进行数据提取。将所得指标按主题相似性分组，对结果进行简要总结。
结果
对所有数据库的系统检索共产生7360条参考文献，其中16条符合纳入标准。这16篇论文共产生了48个独特的指标。总体而言，发现更严重的抑郁严重程度、发病年龄较小、既往治疗反应不佳史、精神共病、躯体共病、童年创伤、心理社会功能损害、年龄较大以及社会经济地位不利与需要高度专业化MDD护理的 proxy 相关。
结论
几个指标与需要高度专业化MDD护理相关。这些指标提供了易于测量的因素，可作为开发有效工具以识别需要高度专业化护理的MDD患者的起点。
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