Prior Anders, Vestergaard Mogens, Larsen Karen Kjær, Fenger-Grøn Morten
Research Unit for General Practice and Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus, Denmark.
BMJ Open. 2018 Feb 24;8(2):e018323. doi: 10.1136/bmjopen-2017-018323.
Mental stress is common in the general population. Mounting evidence suggests that mental stress is associated with multimorbidity, suboptimal care and increased mortality. Delivering healthcare in a biopsychosocial context is key for general practitioners (GPs), but it remains unclear how persons with high levels of perceived stress are managed in primary care. We aimed to describe the association between perceived stress and primary care services by focusing on mental health-related activities and markers of elective/acute care while accounting for mental-physical multimorbidity.
Population-based cohort study.
Primary healthcare in Denmark.
118 410 participants from the Danish National Health Survey 2010 followed for 1 year. Information on perceived stress and lifestyle was obtained from a survey questionnaire. Information on multimorbidity was obtained from health registers.
General daytime consultations, out-of-hours services, mental health-related services and chronic care services in primary care obtained from health registers.
Perceived stress levels were associated with primary care activity in a dose-response relation when adjusted for underlying conditions, lifestyle and socioeconomic factors. In the highest stress quintile, 6.8% attended GP talk therapy (highest vs lowest quintile, adjusted incidence rate ratios (IRR): 4.96, 95% CI 4.20 to 5.86), 3.3% consulted a psychologist (IRR: 6.49, 95% CI 4.90 to 8.58), 21.5% redeemed an antidepressant prescription (IRR: 4.62, 95% CI 4.03 to 5.31), 23.8% attended annual chronic care consultations (IRR: 1.22, 95% CI 1.16 to 1.29) and 26.1% used out-of-hours services (IRR: 1.47, 95% CI 1.51 to 1.68). For those with multimorbidity, stress was associated with more out-of-hours services, but not with more chronic care services.
Persons with high stress levels generally had higher use of primary healthcare, 4-6 times higher use of mental health-related services (most often in the form of psychotropic drug prescriptions), but less timely use of chronic care services.
心理压力在普通人群中很常见。越来越多的证据表明，心理压力与多种疾病、医疗服务欠佳及死亡率增加有关。在生物心理社会背景下提供医疗服务对全科医生（GP）而言至关重要，但目前尚不清楚在初级医疗保健中如何管理感知压力水平较高的人群。我们旨在通过关注与心理健康相关的活动以及择期/急性护理的指标，同时考虑身心共病情况，来描述感知压力与初级医疗服务之间的关联。
基于人群的队列研究。
丹麦的初级医疗保健。
来自2010年丹麦国家健康调查的118410名参与者，随访1年。关于感知压力和生活方式的信息通过调查问卷获得。关于共病的信息从健康登记册中获取。
从健康登记册中获取的初级医疗保健中的一般日间会诊、非工作时间服务、与心理健康相关的服务以及慢性护理服务。
在对潜在疾病、生活方式和社会经济因素进行调整后，感知压力水平与初级医疗保健活动呈剂量反应关系。在压力最高的五分位数组中，6.8%的人接受了全科医生的谈话治疗（最高五分位数组与最低五分位数组相比，调整后的发病率比值（IRR）：4.96，95%CI 4.20至5.86），3.3%的人咨询了心理学家（IRR：6.49，95%CI 4.90至8.58），21.5%的人兑现了抗抑郁药处方（IRR：4.62，95%CI 4.03至5.31），23.8%的人参加了年度慢性护理会诊（IRR：1.22，95%CI 1.16至1.29），26.1%的人使用了非工作时间服务（IRR：1.47，95%CI 1.51至1.68）。对于患有共病的人，压力与更多的非工作时间服务相关，但与更多的慢性护理服务无关。
压力水平高的人通常更多地使用初级医疗保健服务，使用与心理健康相关服务的频率高出4至6倍（最常见的形式是精神药物处方），但慢性护理服务的使用不够及时。
