Centre for Rural Health and School of Applied Human Sciences,University of KwaZulu- Natal,PR Bag X54001,Westville, 3630,South Africa.
Department of Population Health,London School of Hygiene and Tropical Medicine,London,UK.
Epidemiol Psychiatr Sci. 2019 Aug;28(4):418-426. doi: 10.1017/S2045796017000737. Epub 2017 Dec 4.
The aim of this study was to identify the risk correlates for coexisting common mental disorders (CMDs) in the chronic care population in South Africa, with the view to identifying particularly vulnerable patient populations.
The sample comprised 2549 chronic care patients enrolled in the baseline and endline rounds of a facility detection survey conducted by the Programme for Improving Mental Health Care in three large facilities in the Dr Kenneth Kaunda district in the North West province of South Africa. Participants were screened for depression using the Patient Health Questionnaire (PHQ9) and for alcohol misuse using the Alcohol Use Disorders Identification Test (AUDIT). Data were analysed according to the number of morbidities, disorder type (physical or mental) and demographic variables. Multimorbidity was defined as the presence of two or more disorders (physical and/or mental).
Just over one-third of the sample reported two or more physical conditions. Women were more at risk of being depressed than were men, with men more at risk of alcohol misuse. Those who were employed were at lower risk of having coexisting CMDs, while being younger, HIV positive, and food deprived were all found to be associated with higher risk for having coexisting CMDs.
In the face of the large treatment gap for CMDs in South Africa, and the role that coexisting CMDs can play in exacerbating the burden of chronic physical diseases, mental health screening and treatment interventions should target HIV-positive, younger patients living in circumstances where there is household food insecurity.
本研究旨在确定南非慢性护理人群中同时存在的常见精神障碍（CMD）的风险相关因素，以期确定特别脆弱的患者群体。
该样本包括 2549 名在南非西北省肯尼思·卡翁达区的三个大型设施中进行的改善精神卫生保健计划进行的设施发现调查的基线和终线两轮中纳入的慢性护理患者。使用患者健康问卷（PHQ9）对抑郁症进行筛查，使用酒精使用障碍识别测试（AUDIT）对酒精使用障碍进行筛查。根据患病数量、疾病类型（身体或精神）和人口统计学变量对数据进行分析。多种疾病被定义为存在两种或两种以上疾病（身体和/或精神）。
略多于三分之一的样本报告了两种或两种以上的身体状况。女性患抑郁症的风险高于男性，而男性则更易患酒精使用障碍。有工作的人患同时存在的 CMD 的风险较低，而年龄较小、HIV 阳性和食物匮乏都与同时存在的 CMD 风险较高有关。
鉴于南非对 CMD 的治疗差距较大，以及同时存在的 CMD 在加重慢性身体疾病负担方面的作用，精神卫生筛查和治疗干预措施应针对 HIV 阳性、年龄较小、生活在家庭食物不安全环境中的患者。
