University of Sheffield, United Kingdom.
University of Sheffield, United Kingdom.
J Affect Disord. 2018 Feb;227:366-371. doi: 10.1016/j.jad.2017.10.029. Epub 2017 Nov 7.
The prevalence of long-term conditions (LTCs) and multiple-morbidity is increasing. Depression prevalence increases with the number of LTCs. Self-management of LTCs improves outcomes, but depression impacts on self-management. Unscheduled hospital care may be a proxy for failure of planned care to support successful self-management.
Retrospective observational study based on routine NHS datasets covering 19 LTCs. Prevalence of LTCs and depression was identified in all primary care registered adults in one English city (n = 469,368). Chi squared was used for hypothesis testing, and logistic regression to determine the influence of depression and LTC(s) on the use of unscheduled hospital care.
At least one LTC was identified in 220,010 (46.9%) adults; 75,107 (16.0%) had depression; and 38,232 (8.1%) had LTC plus comorbid depression. A significantly greater proportion of individuals with LTC and comorbid depression had ≥ 1 unscheduled event over 12 months (31.5%) compared to individuals with LTC(s) only (24.0%), X(1) = 883.860, p < .001. The logistic regression model explained 4.4% of the variation in unscheduled care use. Individuals with depression plus ≥ 1 LTC were 1.59 times more likely to use unscheduled hospital care than individuals with LTC only (p < .001), after controlling for deprivation, age and number of LTCs.
Cross-sectional data precluded identification of the direction of influence between LTCs and depression. Only 19 major LTCs were studied, so overall LTC prevalence will be under-represented, and other significant predictors may be omitted.
In people with a LTC, comorbidity with depression increases use of unscheduled hospital care.
长期疾病（LTC）和多种疾病的患病率正在增加。抑郁症的患病率随着 LTC 数量的增加而增加。LTC 的自我管理可以改善结果，但抑郁症会影响自我管理。非计划性的医院护理可能是计划护理未能支持成功的自我管理的一个指标。
基于覆盖英格兰一个城市所有初级保健注册成年人的 19 个 LTC 的常规 NHS 数据集的回顾性观察性研究（n = 469368）。确定了所有初级保健注册成年人中 LTC 和抑郁症的患病率。使用卡方检验进行假设检验，使用逻辑回归确定抑郁症和 LTC 对非计划性医院护理使用的影响。
至少有一种 LTC 被确定为 220010 名（46.9%）成年人；75107 名（16.0%）患有抑郁症；38232 名（8.1%）患有 LTC 并伴有合并症性抑郁症。在 12 个月内，患有 LTC 且伴有合并症性抑郁症的个体中，有≥1 次非计划性事件的比例明显高于仅有 LTC（31.5%对 24.0%），X(1) = 883.860，p <.001。逻辑回归模型解释了非计划性护理使用变化的 4.4%。患有抑郁症且伴有≥1 种 LTC 的个体比仅有 LTC 的个体更有可能使用非计划性医院护理（p <.001），在控制了贫困、年龄和 LTC 数量后。
横断面数据排除了 LTC 和抑郁症之间的影响方向。仅研究了 19 种主要的 LTC，因此整体 LTC 患病率将被低估，并且可能会遗漏其他重要的预测因素。
在患有 LTC 的人群中，抑郁症合并症会增加非计划性医院护理的使用。
