Choi Yoon-Joo, Lee Weon-Young
Department of Preventive Medicine, College of Medicine, Chung-Ang University, 84 Heukseok-ro, Dongjak-gu, Seoul 156-756 South Korea.
Int J Ment Health Syst. 2017 Feb 7;11:18. doi: 10.1186/s13033-017-0123-9. eCollection 2017.
Primary care in South Korea has no effective screening system to identify high-risk suicide patients despite to the possibility of hidden patients. The present study examined the prevalence of suicidal ideation and depression among primary care patients and investigated rates of recognition and management strategies of physicians as they encountering patients with suicidal ideation and depression in primary care settings.
This study was conducted as a two-part survey of patients visiting primary care clinics and their physicians. (1) The survey for patients was administered over 17 days in two areas and assessed socio-demographic characteristics, health behavior and the prevalence of suicidal ideation and depression. The participants were 1363 outpatients; 848 lived in urban area, and 515 were from rural area. (2) We surveyed the physicians' recognition of patients with suicidal ideations and depression as well as their current management. Eighteen doctors at 15 local clinics (8 in urban area and 7 in rural area) participated in this survey.
The prevalence rates of suicidal ideation and depression (Patient Health Questionnaire-9 ≥ 10) were 18.3% (95% confidence interval: 16.2-20.3) and 13.9% (95% CI 12.6-15.7), respectively in primary care settings. The rates of suicidal ideation and depression were approximately 2.4 times and 1.4 times higher, respectively than those in community dwelling people. Ten (69.7%) and 4 (26.7%) of the 15 clinics staffed physicians who did not recognize suicidal ideation and depression, respectively. Five (83.3%) of 6 and 4 (38.6%) of 14 physicians who recognized suicidal ideation and depression among their patients respectively, only recommended psychiatry without any arrangements for a referral.
Our findings imply that many patients with suicidal ideations and depression in primary care settings are under-diagnosed and under-treated. As a result, education and training of the identification and management of suicidal ideation and depression should be made available to physicians in primary care settings.
尽管韩国初级保健中可能存在隐匿性自杀风险患者，但目前尚无有效的筛查系统来识别这类高危患者。本研究调查了初级保健患者中自杀意念和抑郁的患病率，并探讨了在初级保健环境中，医生在遇到有自杀意念和抑郁的患者时的识别率及管理策略。
本研究通过对前往初级保健诊所的患者及其医生进行两部分调查来开展。（1）在两个地区对患者进行了为期17天的调查，评估社会人口学特征、健康行为以及自杀意念和抑郁的患病率。参与者为1363名门诊患者，其中848名居住在城市地区，515名来自农村地区。（2）我们调查了医生对有自杀意念和抑郁患者的识别情况以及他们目前的管理方式。15家当地诊所的18名医生（城市地区8名，农村地区7名）参与了此次调查。
在初级保健环境中，自杀意念和抑郁（患者健康问卷-9≥10）的患病率分别为18.3%（95%置信区间：16.2-20.3）和13.9%（95%CI 12.6-15.7）。自杀意念和抑郁的患病率分别比社区居民高出约2.4倍和1.4倍。15家诊所中，分别有10名（69.7%）和4名（26.7%）医生未识别出自杀意念和抑郁。在识别出患者有自杀意念和抑郁的医生中，6名中有5名（83.3%）、14名中有4名（38.6%）仅建议患者去看精神科，而未安排任何转诊事宜。
我们的研究结果表明，在初级保健环境中，许多有自杀意念和抑郁的患者未得到充分诊断和治疗。因此，应向初级保健医生提供有关自杀意念和抑郁识别与管理的教育和培训。
