Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, POB. 400, 4002, Hungary.
National Institute of Health Promotion, Budapest, Hungary.
Soc Psychiatry Psychiatr Epidemiol. 2019 Feb;54(2):255-276. doi: 10.1007/s00127-018-1545-7. Epub 2018 Jun 15.
We determined the prevalence of untreated depression in patients with hypertension (HT) and/or diabetes (DM) and estimated the extra health care use and expenditures associated with this comorbidity in a rural Hungarian adult population. We also assessed the potential workload of systematic screening for depression in this patient group.
General health check database from a primary care programme containing survey data of 2027 patients with HT and/or DM was linked to the outpatient secondary care use database of National Institute of Health Insurance Fund Management. Depression was ascertained by Beck Depression Inventory score and antidepressant drug use. The association between untreated depression and secondary healthcare utilization indicated by number of visits and expenses was evaluated by multiple logistic regression analysis controlled for socioeconomic/lifestyle factors and comorbidity. The age-, sex- and education-specific observations were used to estimate the screening workload for an average general medical practice.
The frequency of untreated depression was 27.08%. The untreated severe depression (7.45%) was associated with increased number of visits (OR 1.60, 95% CI 1.11-2.31) and related expenses (OR 2.20, 95% CI 1.50-3.22) in a socioeconomic status-independent manner. To identify untreated depression cases among patients with HT and/or DM, an average GP has to screen 42 subjects a month.
It seems to be reasonable and feasible to screen for depression in patients with HT and/or DM in the primary care, in order to detect cases without treatment (which may be associated with increase of secondary care visits and expenditures) and to initiate the adequate treatment of them.
我们旨在确定高血压（HT）和/或糖尿病（DM）患者中未治疗的抑郁症的患病率，并评估这种合并症在匈牙利农村成年人群中与额外的医疗保健使用和支出相关。我们还评估了在这一患者群体中进行系统性抑郁症筛查的潜在工作量。
将初级保健计划中的一般健康检查数据库与国家健康保险基金管理研究所的门诊二级保健使用数据库相关联，该数据库包含 2027 名 HT 和/或 DM 患者的调查数据。通过贝克抑郁量表评分和抗抑郁药物使用情况来确定抑郁症。通过多变量逻辑回归分析评估未经治疗的抑郁症与就诊次数和费用等表示的二级医疗保健利用之间的关联，该分析控制了社会经济/生活方式因素和合并症。使用年龄、性别和教育特定的观察值来估计普通全科医生的筛查工作量。
未经治疗的抑郁症的频率为 27.08%。未经治疗的严重抑郁症（7.45%）与就诊次数的增加（OR 1.60，95%CI 1.11-2.31）和相关费用（OR 2.20，95%CI 1.50-3.22）独立相关，与社会经济地位无关。为了在 HT 和/或 DM 患者中识别未经治疗的抑郁症病例，平均每位全科医生每月需要筛查 42 名患者。
在初级保健中对 HT 和/或 DM 患者进行抑郁症筛查似乎是合理且可行的，以便发现未经治疗的病例（这可能与就诊次数和支出的增加有关），并为其启动适当的治疗。
